Methods and systems for performing optical coherence tomography

ABSTRACT

Configurations are disclosed for a health system to be used in various healthcare applications, e.g., for patient diagnostics, monitoring, and/or therapy. The health system may comprise a light generation module to transmit light or an image to a user, one or more sensors to detect a physiological parameter of the user&#39;s body, including their eyes, and processing circuitry to analyze an input received in response to the presented images to determine one or more health conditions or defects.

RELATED APPLICATIONS

This non-provisional patent application claims priority under 35 U.S.C.120 from U.S. application Ser. No. 15/072,290 filed on Mar. 16, 2016titled “METHODS AND SYSTEMS FOR DIAGNOSING AND TREATING HEALTH AILMENTS”which is hereby incorporated by reference in its entirety. U.S.application Ser. No. 15/072,290 claims priority under 35 U.S.C. 119(e)from U.S. Provisional Application Ser. No. 62/133,870 filed on Mar. 16,2015 titled “METHODS AND SYSTEM FOR DIAGNOSING AND TREATING HEALTHAILMENTS” which is hereby incorporated by reference herein in itsentirety.

The aforementioned patent applications as well as U.S. application Ser.No. 14/555,585 titled “VIRTUAL AND AUGMENTED REALITY SYSTEMS ANDMETHODS”, and U.S. Prov. Application Ser. No. 62/005,834, titled“METHODS AND SYSTEM FOR CREATING FOCAL PLANES IN VIRTUAL AND AUGMENTEDREALITY” are each hereby expressly incorporated by reference herein intheir entirety for all purposes. Any and all applications for which aforeign or domestic priority claim is identified in the Application DataSheet as filed with the present application are hereby incorporated byreference in their entirety under 37 CFR 1.57.

FIELD

The present disclosure relates to various methods and systems fordiagnosing, monitoring, and treating health conditions and ailments,including ophthalmic as well as other conditions and ailments.

BACKGROUND

Ophthalmic instruments and techniques are routinely used by cliniciansto diagnose and treat eye-related ailments. An example of a traditionalophthalmic device is shown in FIG. 1. As illustrated, the patient may bepositioned in a specific, seated position for the entire duration of theprocedure, which may last anywhere between a few seconds to a fewminutes. This positioning has been considered necessary to properlyalign the patient's eye with the ophthalmic device, to performmeasurements and/or therapeutic procedures on the patient's eyes.

Undesirably, ophthalmic devices tend to be large, bulky and expensivedevices, and are typically used exclusively in doctor's offices. Thus,patients may be required to make an appointment with an optometrist andvisit the doctor for any diagnoses or treatment to take place. This canbe a deterring factor for many patients, who may delay the trip to thedoctor's office for long periods of time, possibly until a condition hasworsened. The worsened condition may require even more drastic therapiesor procedures to address, when it could have been more easily alleviatedhad the patient been timely diagnosed or treated. Furthermore, the largeand bulky nature of most ophthalmic devices forces patients to be placedin an uncomfortable position for a large amount of time, which in turnmay actually increase risks of mis-diagnoses and patient error.

Accordingly, there is a need for health systems that address one or moreof the difficulties above.

SUMMARY

Example embodiments described herein have innovative features, no singleone of which is indispensable or solely responsible for their desirableattributes. Without limiting the scope of the claims, some of theadvantageous features will now be summarized.

An innovative aspect of the subject matter described herein can beimplemented in a user-wearable diagnostic health system comprising aframe, an augmented reality display attached to the frame, a lightdetector attached to the frame and a processor configured to conduct ahealth analysis of the user based on light detected by the lightdetector. The frame is configured to mount on the user. The augmentedreality display is configured to direct images to an eye of the user.The light detector is configured to detect light reflected from an eyeof the user.

Another innovative aspect of the subject matter described herein can beimplemented in a user-wearable diagnostic health system comprising aframe, an augmented reality display attached to the frame, a soundemitter configured to emit sound waves toward the user, a sound detectorattached to the frame and configured to detect sound waves reflectedfrom the user, and a processor configured to conduct a health analysisof the user based on information detected by the sound detector. Theframe is configured to mount on the user. The augmented reality displayis configured to direct images to an eye of the user.

Yet another innovative aspect of the subject matter described herein canbe implemented in a user-wearable therapeutic health system comprising aframe configured to mount on the user, an augmented reality displayattached to the frame and a processor configured to direct the augmentedreality display to conduct a health therapy protocol on the user. Theaugmented reality display is further configured to direct images to aneye of the user.

An innovative aspect of the subject matter described herein can beimplemented in a wearable diagnostic health system comprising a frameconfigured to mount on a clinician, an augmented reality displayattached to the frame and configured to direct images to an eye of theclinician, an outward-facing image capture device configured to image aneye of a patient and a processor configured to conduct a health analysisof the patient based on the image of the eye captured by the imagecapture device.

Additional example embodiments are provided below. Note that structuresfor various health analyses and/or therapies may coexist in the samehealth system. Moreover, as disclosed herein, the same feature may beapplied to facilitate multiple health analyses and/or therapies. Forexample, structures used for delivering medication may also be utilizedfor various diagnostics, as disclosed herein. Consequently, healthsystems according to some embodiments may include various combinationsof the structural features disclosed herein, including combinations offeatures disclosed under different headings. In addition, the healthsystem may be configured to perform various combinations of the healthanalyses and therapies disclosed herein, including those disclosed underdifferent headings. Accordingly, a variety of example embodiments areset for below.

Myopia/Hyeropia/Astigmatism

1. A wearable ophthalmic device, comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into an eye of a        person to form an image in the eye; and    -   a waveguide stack comprising one or more waveguides, wherein        each of the one or more waveguides is configured to project the        light at one of the one or more focal planes,    -   wherein the image is modified by a wavefront correction based on        an optical prescription for the eye.

2. The device of embodiment 1, wherein the waveguide stack furthercomprises one or more lenses.

3. The device of embodiment 1, wherein the head-mounted display systemcomprises an augmented reality head-mounted ophthalmic system configuredto pass light from the world into the eye of the person wearing thehead-mounted system.

4. The device of embodiment 1, wherein the optical prescriptioncomprises a prescription for myopia.

5. The device of embodiment 1, wherein the optical prescriptioncomprises a prescription for hyperopia.

6. The device of embodiment 1, wherein the optical prescriptioncomprises a prescription for astigmatism.

7. A wearable ophthalmic device, comprising:

-   -   an augmented reality head-mounted display system configured to        pass light from the world into an eye of a person wearing the        head-mounted system;    -   a light source configured to direct light into an eye of the        person to form an image in the eye; and    -   an adaptable optics element configured to apply a wavefront        correction to the image based on an optical prescription for the        eye.

8. The device of embodiment 7, wherein the adaptable optics elementcomprises a variable focus element.

9. The device of embodiment 8, wherein the variable focus elementcomprises a membrane mirror.

10. The device of embodiment 9, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of

the membrane mirror based on a corneal shape of the eye.

11. The device of embodiment 7, wherein the optical prescriptioncomprises a prescription for myopia.

12. The device of embodiment 7, wherein the optical prescriptioncomprises a prescription for hyperopia.

13. The device of embodiment 7, wherein the optical prescriptioncomprises a prescription for astigmatism.

14. A wearable ophthalmic device, comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of a        person to form an image in the eye; and    -   an adaptable optics element configured to apply a wavefront        correction to the image based on an optical prescription for the        eye, wherein the adaptable optics comprises a membrane mirror.

15. The device of embodiment 14, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of

the membrane mirror based on a corneal shape of the eye.

16. The device of embodiment 14, wherein the optical prescriptioncomprises a prescription for myopia.

17. The device of embodiment 14, wherein the optical prescriptioncomprises a prescription for hyperopia.

18. The device of embodiment 14, wherein the optical prescriptioncomprises a prescription for astigmatism.

19. A wearable ophthalmic device, comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into an eye of a        person to form an image in the eye, the light source comprising        a fiber scanning projector,    -   wherein the image is modified by a wavefront correction based on        an optical prescription for the eye.

20. The device of embodiment 19, wherein the optical prescriptioncomprises a prescription for myopia.

21. The device of embodiment 19, wherein the optical prescriptioncomprises a prescription for hyperopia.

22. The device of embodiment 19, wherein the optical prescriptioncomprises a prescription for astigmatism.

23. A wearable augmented reality ophthalmic device, comprising:

-   -   an augmented reality head-mounted ophthalmic system configured        to pass light from the world into an eye of a person wearing the        head-mounted system; and    -   a light source configured to project light into the eye of the        person to form an image in the eye, the image being modified by        a wavefront correction based on an optical prescription for the        eye.

24. The device of embodiment 23, wherein the optical prescriptioncomprises a prescription for myopia.

25. The device of embodiment 23, wherein the optical prescriptioncomprises a prescription for hyperopia.

26. The device of embodiment 23, wherein the optical prescriptioncomprises a prescription for astigmatism.

27. A method for addressing vision defects of a person wearing a headmounted display system, comprising:

-   -   identifying an optical prescription of said person;    -   producing an image using a display in the head mounted display        system;    -   applying wavefront correction to said image based on said        prescription to yield a corrected image; and    -   displaying the corrected image to the person wearing the head        mounted display.

28. The method of embodiment 27, wherein identifying an opticalprescription of the person comprises receiving input from the personspecifying the prescription.

29. The method of embodiment 27, wherein identifying an opticalprescription of the person comprises presenting the person withdifferent wavefront corrections.

30. The method of embodiment 29, further comprising receiving input fromthe person specifying the preferred correction.

31. The method of embodiment 27, wherein the wavefront correction isimplemented by adjusting adaptive optics in the head mounted display.

32. The method of embodiment 31, wherein the adaptive optics comprises avariable focus element.

33. The method of embodiment 31, wherein the adaptive optics comprises adeformable optical element.

34. The method of embodiment 38, wherein the deformable optical elementcomprises a deformable mirror.

35. The method of embodiment 27, wherein the wavefront correction isimplemented by using a waveguide stack comprising a plurality ofwaveguides configured to provide different focal planes.

36. The method of embodiment 35, wherein the wavefront correction isimplemented by directing said image through the combination ofwaveguides that provide the desired optical power to provide thewavefront correction.

37. The method of embodiment 27, further comprising providing differentimage content at different depth planes.

38. The method of embodiment 37, wherein said providing different imagecontent at different depth planes comprising providing different imagecontent through different waveguides in a waveguide stack therebyproviding different optical power to different image content.

39. The method of embodiment 38, wherein different image contentpropagates through a different number of waveguides thereby providingdifferent optical power to different image content.

40. The method of embodiment 39, wherein said waveguides include staticoptical elements having optical power.

41. The method of embodiment 27, wherein the wavefront correction isimplemented by directing said image through at least one waveguide.

42. The method of embodiment 41, wherein said at least one waveguideincludes a dynamic optical element having variable optical power.

43. The method of embodiment 27, wherein said optical correction isconfigured to correct for myopia.

44. The method of embodiment 27, wherein said optical correction isconfigured to correct for hyperopia.

45. The method of embodiment 27, wherein said optical correction isconfigured to correct for astigmatism.

46. The method of embodiment 27, wherein applying the wavefrontcorrection comprises accessing processing electronics.

47. The method of embodiment 27, wherein said wavefront correction isapplied to a virtual reality image.

48. The method of embodiment 27, wherein said wavefront correction isapplied to an augmented reality image.

49. The method of embodiment 27, wherein said wavefront correction isapplied to said image from said display and in imaging objects in frontof said head mounted display and said person wearing said head mounteddisplay.

50. A wearable ophthalmic device, comprising:

-   -   a light source and wearable optics configured to direct light        into the eye of the person wearing said wearable optics to form        an image in said eye, said wearable optics configured to provide        prescription refractive correction to said image based on an        optical prescription for said person's eye.

51. The device of embodiment 50, further comprising user interfacecontrols configured to receive input from the person specifying theperson's optical prescription.

52. The device of embodiment 50, configured to present the person withdifferent wavefront corrections to identify an optical prescription ofthe person.

53. The device of embodiment 52, further comprising a user interfaceconfigured to receive input from the person specifying the preferredcorrection.

54. The device of embodiment 50, wherein said wearable optics compriseadaptive optics in the wearable optics configured to be adjusted toimplement the correction.

55. The device of embodiment 54, wherein the adaptive optics comprises avariable focus element.

56. The device of embodiment 54, wherein the adaptive optics comprises adeformable optical element.

57. The device of embodiment 56, wherein the deformable optical elementcomprises a deformable mirror.

58. The device of embodiment 50, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides configured toprovide different focal planes, said waveguide stack configured toprovide the prescription correction.

59. The device of embodiment 58, wherein the waveguide stack comprises acombination of waveguides that provide the desired optical power toprovide the prescription correction, said prescription correction beingimplemented by directing said light through the combination ofwaveguides.

60. The device of embodiment 50, wherein the wearable optic comprisedifferent depth planes, said wearable optics configured to providedifferent image content at said different depth planes.

61. The device of embodiment 60, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides, said providingdifferent image content at different depth planes comprising providingdifferent image content through different waveguides in a waveguidestack thereby providing different optical power to different imagecontent.

62. The device of embodiment 61, wherein different image contentpropagates through a different number of waveguides thereby providingdifferent optical power to different image content.

63. The device of embodiment 58, wherein said waveguides include staticoptical elements having optical power.

64. The device of embodiment 50, wherein said wearable optics comprisesat least one waveguide, wherein the prescription correction isimplemented by directing said light through at least one waveguide.

65. The device of embodiment 64, wherein said at least one waveguideincludes a dynamic optical element having variable optical power.

66. The device of embodiment 50, wherein said prescription correction isconfigured to correct for myopia.

67. The device of embodiment 50, wherein said prescription correction isconfigured to correct for hyperopia.

68. The method of embodiment 50, wherein said prescription correction isconfigured to correct for astigmatism.

69. The method of embodiment 50, further comprising processingelectronics configured to be accessed to provide the prescriptioncorrection.

70. The device of embodiment 69, further comprising a sensor todetermine orientation of said person's head.

71. The device of embodiment 70, wherein said sensor comprises agyroscopic sensor.

72. The device of embodiment 70, wherein said wearable optics isconfigured to alter the focus of said image based on said head position.

73. The device of embodiment 69, wherein said wearable optics comprisesa variable focus element configured to vary a focus of said image toprovide said correction.

74. The device of embodiment 69, further comprising an eye trackingsystem configured to determine a person's convergence point.

75. The device of embodiment 74, wherein said wearable optics isconfigured to alter the focus of said image based on said determinedconvergence point.

76. The device of any of embodiments 50, wherein said device comprises avirtual reality device configured to provide said prescriptioncorrection to virtual reality image content.

77. The device of any of embodiments 50, wherein said device comprisesan augmented reality system configured to provide said prescriptioncorrection to augmented reality image content.

78. The device of embodiment 77, wherein said wearable optics areconfigured such that said prescription correction is applied to an imageformed from light from said light source and to images formed fromobjects in front of said device and said person wearing said wearableoptics.

79. The method of embodiment 27, wherein identifying the opticalprescription of the person comprises identifying a plurality of opticalprescriptions at a plurality of intervals, wherein each opticalprescription corresponds to an interval.

80. The method of embodiment 79, wherein the wavefront correction isdynamically adjusted based on the each optical prescription.

81. The device of embodiment 52, configured to identify a plurality ofoptical prescriptions at plurality of intervals, wherein each opticalprescription corresponds to an interval, wherein the refractivecorrection is dynamically adjusted based on each optical prescription.

82. The device of embodiment 7, wherein the augmented realityhead-mounted display system comprises a display lens configured to passlight from the world into an eye of a person wearing the head-mountedsystem, and wherein the adaptable optics element is positioned betweenthe display lens and a source of the light from the world.

83. The device of embodiment 7, wherein the augmented realityhead-mounted display system comprises a display lens configured to passlight from the world into an eye of a person wearing the head-mountedsystem, and wherein the adaptable optics element is positioned betweenthe display lens and the eye of the user.

84. The device of embodiment 7, wherein the adaptable optics element arepositioned between the light source and the eye of the user.

85. The device of embodiment 7, wherein the adaptable optics element areintegrated into the light source.

86. The device of any of embodiments 50, wherein said device comprisesan augmented reality system configured pass ambient light from in frontof the person to the eye of the person to provide, wherein said deviceis further configured to provide said prescription correction to theambient light.

87. The device of embodiment 58, wherein said wearable optics compriseadaptive optics in the wearable optics configured to be adjusted toimplement the correction.

88. The device of embodiment 87, wherein the adaptive optics ispositioned in at least one of:

between the light source and the waveguide stack;

between at least one of the plurality of waveguides and another one ofthe plurality of waveguides;

between the waveguide stack and the eye of the person; and

between the waveguide stack and an ambient light source from in front ofsaid device.

89. The device of embodiment 87, wherein the adaptive optics isintegrated in at least one of the waveguide stack and the light source.

90. The method of embodiment 27, further comprising:

-   -   passing ambient light from the world in front of the person and        in front of the head mounted display device;    -   applying wavefront correction to said ambient light based on        said prescription;    -   displaying the corrected ambient light to the person, wherein        the corrected ambient light is displayed with the corrected        image.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Presbyopia

1. A wearable ophthalmic device for addressing presbyopia, comprising:

-   -   a head-mounted ophthalmic system;    -   a sensor configured to determine an orientation of a gaze of a        person;    -   a light source configured to direct a light form into an eye of        the person to form an image in the eye; and    -   an adaptive optics element through which the light form is        projected, wherein the adaptive optics element is configured to        modify a focus of the image based on the orientation of the gaze        of the person.

2. The device of embodiment 1, wherein the orientation of the gaze ofthe person is based on a position of a head of the person.

3. The device of embodiment 1, further comprising gyroscopic sensors todetermine a position of a head of the person.

4. The device of embodiment 1, wherein the orientation of the gaze ofthe person is determined by tracking a position of the eye.

5. A wearable ophthalmic device, comprising:

-   -   a light source and wearable optics configured to direct light        into the eye of the person wearing said wearable optics to form        an image in said eye, said wearable optics configured to correct        for presbyopia based on an optical prescription for said        person's eye.

6. The device of embodiment 5, further comprising user interfacecontrols configured to receive input from the person specifying theperson's optical prescription.

7. The device of embodiment 5, configured to present the person withdifferent wavefront corrections to identify an optical prescription ofthe person.

8. The device of embodiment 7, further comprising a user interfaceconfigured to receive input from the person specifying the preferredcorrection.

9. The device of embodiment 5, wherein said wearable optics compriseadaptive optics in the wearable optics configured to be adjusted toimplement the correction.

10. The device of embodiment 9, wherein the adaptive optics comprises avariable focus element.

11. The device of embodiment 9, wherein the adaptive optics comprises adeformable optical element.

12. The device of embodiment 11, wherein the deformable optical elementcomprises a deformable mirror.

13. The device of embodiment 5, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides configured toprovide different focal planes, said waveguide stack configured toprovide the prescription correction.

14. The device of embodiment 13, wherein the waveguide stack comprises acombination of waveguides that provide the desired optical power toprovide the prescription correction, said prescription correction beingimplemented by directing said light through the combination ofwaveguides.

15. The device of embodiment 5, wherein the wearable optics providedifferent depth planes, said wearable optics configured to providedifferent image content at said different depth planes.

16. The device of embodiment 15, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides, said providingdifferent image content at different depth planes comprising providingdifferent image content through different waveguides in a waveguidestack thereby providing different optical power to different imagecontent.

17. The device of embodiment 16, wherein different image contentpropagates through a different number of waveguides thereby providingdifferent optical power to different image content.

18. The device of embodiment 13, wherein said waveguides include staticoptical elements having optical power.

19. The device of embodiment 5, wherein said wearable optics comprisesat least one waveguide, wherein the prescription correction isimplemented by directing said light through at least one waveguide.

20. The device of embodiment 19, wherein said at least one waveguideincludes a dynamic optical element having variable optical power.

21. The device of embodiment 5, further comprising processingelectronics configured to be accessed to provide the prescriptioncorrection.

22. The device of embodiment 21, further comprising a sensor todetermine orientation of said person's head.

23. The device of embodiment 22, wherein said sensor comprises agyroscopic sensor.

24. The device of embodiment 22, wherein said wearable optics isconfigured to alter the focus of said image based on said head position.

25. The device of embodiment 21, wherein said wearable optics comprisesa variable focus element configured to vary a focus of said image toprovide said correction.

26. The device of embodiment 21, further comprising an eye trackingsystem configured to determine a person's convergence point.

27. The device of embodiment 26, wherein said wearable optics isconfigured to alter the focus of said image based on said determinedconvergence point.

28. The device of embodiment 5, wherein said device comprises a virtualreality device configured to provide said prescription correction tovirtual reality image content.

29. The device of embodiment 5, wherein said device comprises anaugmented reality system configured to provide said prescriptioncorrection to augmented reality image content.

30. The device of embodiment 29, wherein said wearable optics areconfigured such that said prescription correction is applied to an imageformed from light from said light source and to images formed fromobjects in front of said device and said person wearing said wearableoptics.

31. The device of embodiment 5, further comprising electronicsconfigured to determine the person's gaze based on movement of one ormore of the person's eyes.

32. The device of embodiment 31, wherein the said wearable optics isconfigured to alter the focus of said image based on said determinedgaze.

33. The device of embodiment 31, wherein a downward movement of one ormore of the person's eyes is indicative of the person focusing at anear-field focal depth.

34. The device of embodiment 33, wherein the said wearable optics isconfigured to increase the optical power of a portion of the saidwearable optics based on the optical prescription for said person's eye.

35. The device of embodiment 16, further comprising an electronicsconfigured to determine the person's gaze based on movement of one ormore of the person's eyes.

36. The device of embodiment 1, wherein the sensor comprises aneye-tracking system configured to determine the convergence point of theeye of the person.

37. The device of embodiment 4, wherein an angle of convergence isdetermined based on the position of the eye, wherein the focus ismodified based on the angle of convergence.

38. The device of embodiment 31, wherein a downward movement of one ormore of the person's eyes is indicative of an increase in an angle ofthe convergence of the eyes, wherein an increase in the angle of theconvergence of the eye is indicative of the person focusing at anear-field focal depth.

39. The device of embodiment 5, further comprising a biofeedback systemconfigured to determine the wavefront correction based on monitoring oneor more properties of the eye while viewing the image.

40. The device of embodiment 40, wherein the biofeedback system receivesinputs from at least one of a phoropter, an autorefractor, and an eyetracking system.

41. The device of embodiment 40, wherein the properties of the eye is atleast one of: changes in a convergence point of the eye, changes in aposition of a head of the person, change in a size of a pupil of theeye.

42. The device of embodiment 5, further comprising electronicsconfigured to determine the person's gaze based on glint detection.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Strabismus/Amblyopia

1. A wearable augmented reality device configured to be used by a wearerhaving eyes having an inability to align at a single convergence point,said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system;    -   a light source configured to project light into the eye of the        wearer to form an image in the eye; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the image is modified to add compensating prism        correction to bring the convergence point of both eyes together.

2. A wearable virtual reality device configured to be used by a wearerhaving eyes having an inability to align at a single convergence point,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display        for providing images to an eye of the wearer;    -   a light source configured to project light into the eye of the        wearer to form an image in the eye; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the image is modified to add compensating prism        correction to bring the convergence point of both eyes together.

3. A wearable augmented reality device configured to be used by a wearerhaving eyes having an inability to align at a single convergence point,said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system;    -   a light source configured to project light into the eye of the        wearer to form an image in the eye;    -   an eye tracking system configured to determine gaze of said eye;        and    -   an adaptable optics element configured to add compensating prism        correction to bring the convergence point of both eyes together.

4. The device of embodiment 3, wherein the adaptable optics elementcomprises a variable focus element.

5. The device of embodiment 4, wherein the variable focus elementcomprises a membrane mirror.

6. The device of embodiment 5, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

7. A wearable virtual reality device configured to be used by a wearerhaving eyes having an inability to align at a single convergence point,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display        for providing images to an eye of the wearer;    -   a light source configured to project light into the eye of the        wearer to form an image in the eye;    -   an eye tracking system configured to determine gaze of said eye;        and    -   an adaptable optics element configured to add compensating prism        correction to bring the convergence point of both eyes together.

8. The device of embodiment 7, wherein the adaptable optics elementcomprises a variable focus element.

9. The device of embodiment 8, wherein the variable focus elementcomprises a membrane mirror.

10. The device of embodiment 9, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

11. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddisplay device comprising:

-   -   a wearable head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of said        wearer to form an image in the eye, the light source comprising        a fiber scanning projector; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the light source is configured to add compensating prism        correction to bring the convergence point of both eyes together.

12. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddisplay device comprising:

-   -   a wearable head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of said        wearer to form an image in the eye;    -   a waveguide stack comprising a plurality of waveguides, wherein        different waveguides are configured to project light from        different depth planes; and    -   an eye tracking system configured to determine gaze of said eye.    -   wherein the image is modified to add compensating prism        correction to bring the convergence point of both eyes together.

13. The device of embodiment 12, wherein the waveguide stack furthercomprises one or more lenses.

14. The device of embodiment 12, wherein the head-mounted ophthalmicsystem comprises an augmented reality display platform, saidhead-mounted ophthalmic system configured to pass light from the worldinto the eye of the wearer wearing the head-mounted display system.

15. A wearable augmented reality device configured to be used by awearer having eyes having an inability to align at a single convergencepoint, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;    -   a light source configured to direct light into the eye of the        wearer to form an image in the eye; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the wearable augmented reality device is configured to        re-train to gradually align the convergence point of both eyes.

16. The device of embodiment 15, wherein the wearable augmented realitydevice is configured to re-train by occluding one eye.

17. The device of embodiment 15, wherein the wearable augmented realitydevice is configured to re-train by reducing intensity of light into oneeye.

18. The device of embodiment 15, wherein the wearable augmented realitydevice is configured to re-train by defocusing the light directed intoone eye.

19. A wearable virtual reality device configured to be used by a wearerhaving eyes having an inability to align at a single convergence point,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to an eye of the wearer;    -   a light source configured to direct light into the eye of the        wearer to form an image in the eye; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the wearable virtual reality device is configured to        re-train to gradually align the convergence point of both eyes.

20. The device of embodiment 19, wherein the wearable virtual realitydevice is configured to re-train by occluding one eye.

21. The device of embodiment 19, wherein the wearable virtual realitydevice is configured to re-train by reducing intensity of light into oneeye.

22. The device of embodiment 19, wherein the wearable virtual realitydevice is configured to re-train by defocusing the light directed intoone eye.

23. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddevice comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted        ophthalmic system;    -   a light source configured to direct light into the eye of the        wearer to form an image in the eye;    -   an adaptable optics element configured to modify said image; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the wearable display device is configured to re-train to        gradually align the convergence point of both eyes.

24. The device of embodiment 23, wherein the adaptable optics elementcomprises a variable focus element.

25. The device of embodiment 24, wherein the variable focus elementcomprises a membrane mirror.

26. The device of embodiment 25, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

27. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddevice comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of the        wearer to form an image in the eye;    -   an adaptable optics element configured to modify said image; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the wearable display device is configured to re-train to        gradually align the convergence point of both eyes.

28. The device of embodiment 27, wherein the adaptable optics elementcomprises a variable focus element.

29. The device of embodiment 28, wherein the variable focus elementcomprises a membrane mirror.

30. The device of embodiment 29, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

31. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddevice comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of the        wearer to form an image in the eye, the light source comprising        a fiber scanning projector; and    -   an eye tracking system configured to determine gaze of said eye.    -   wherein the wearable display device is configured to re-train to        gradually align the convergence point of both eyes.

32. A wearable display device configured to be used by a wearer havingeyes having an inability to align at a single convergence point, saiddevice comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of the        wearer to form an image in the eye;    -   a waveguide stack comprising a plurality of waveguides, wherein        different waveguides are configured to project light from        different depth planes; and    -   an eye tracking system configured to determine gaze of said eye,    -   wherein the wearable display device is configured to re-train to        gradually align the convergence point of both eyes.

33. The device of embodiment 32, wherein the waveguide stack furthercomprises one or more lenses.

34. The device of embodiment 32, wherein the head-mounted ophthalmicsystem comprises an augmented reality display platform, saidhead-mounted ophthalmic system configured to pass light from the worldinto the eye of the wearer wearing the head-mounted display system.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Higher Order Aberrations

1. A wearable augmented reality device configured to be used by aperson, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of the person wearing the head-mounted system;        and    -   at least one light source and wearable optics configured to        project light into the eye of the person to form an image in the        eye, said at least one light source and wearable optics        configured to provide refractive correction for higher order        refractive errors.

2. The device of embodiment 1, wherein said at least one light sourcecomprises a fiber scanning display.

3. The device of embodiment 1, further comprising user interfacecontrols configured to receive an input specifying the person's opticalprescription.

4. The device of embodiment 1, wherein said wearable optics compriseadaptive optics in the wearable optics configured to be adjusted toimplement the refractive correction.

5. The device of embodiment 4, wherein the adaptive optics comprises avariable focus element.

6. The device of embodiment 4, wherein the adaptive optics comprises adeformable optical element.

7. The device of embodiment 6, wherein the deformable optical elementcomprises a deformable mirror.

8. The device of embodiment 1, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides configured toprovide different focal planes.

9. The device of embodiment 1, wherein the wearable optics comprisedifferent depth planes, said wearable optics configured to providedifferent image content at said different depth planes.

10. The device of embodiment 9, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides, said providingdifferent image content at different depth planes comprising providingdifferent image content through different waveguides in a waveguidestack thereby providing different optical power to different imagecontent.

11. The device of embodiment 10, wherein different image contentpropagates through a different number of waveguides thereby providingdifferent optical power to different image content.

12. The device of embodiment 8, wherein said waveguides include staticoptical elements having optical power.

13. The device of embodiment 1, wherein said wearable optics comprisesat least one waveguide.

14. The device of embodiment 13, wherein said at least one waveguideincludes a dynamic optical element having variable optical power.

15. The device of embodiment 1, further comprising processingelectronics configured to be accessed to provide the refractivecorrection.

16. The device of embodiment 1, wherein said wearable optics areconfigured such that said refractive correction is applied to an imageformed from light from said light source and to images formed fromobjects in front of said device and said person wearing said wearableoptics.

17. A wearable virtual reality device configured to be used by a person,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising an        virtual reality display platform comprising a display for        providing images to the eye of the person; and    -   at least one light source and wearable optics configured to        project light into the eye of the person to form an image in the        eye, said at least one light source and wearable optics        configured to provide refractive correction for higher order        refractive errors.

18. The device of embodiment 1, further comprising a receiver circuitconfigured to receive input from a remote source specifying the person'soptical prescription.

19. The device of embodiment 1, further comprising a receiver configuredto receive, from a memory circuit external to the wearable augmentedreality device, an optical prescription stored on the memory circuit,wherein the wearable augmented reality device provides refractivecorrection based on the received optical prescription.

20. The device of embodiment 17, further comprising an outward facingcamera configured to obtain images of light formed from objects in frontof said device, wherein the image provided to the eye of the personcomprises the obtained images.

21. The device of embodiment 3, wherein the user interface controls areconfigured to receive the input from at least one of the person, a thirdparty, and a doctor.

22. The device of embodiment 15, wherein the wearable optics areconfigured to provide refractive correction in real-time as the lightforming the image is projected into the eye of the person.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Chromatic Aberrations

1. A wearable augmented reality device configured to be used by aperson, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a person wearing the head-mounted        system, said augmented reality display platform comprising        optics configured to project an image in said eye,    -   wherein said augmented reality display is configured to project        a first color component of the image at a first depth plane and        a second color component of the image at a second depth plane        different than the first depth plane to compensate for        longitudinal chromatic aberration of the person's eye.

2. The device of embodiment 1, wherein said augmented reality display isconfigured to output a third color component of the image at a thirddepth plane different than the first and second depth planes tocompensate for longitudinal chromatic aberration of the person's eye.

3. The device of embodiment 1, wherein said first color component isred.

4. The device of embodiment 1, wherein said second color component isgreen.

5. The device of embodiment 2, wherein said third color component isblue.

6. The device of embodiment 1, further comprising a user interface forreceiving a prescription for said longitudinal chromatic aberration.

7. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to vary the focus of theimage automatically to provide incremental change in opticalprescription thereby conducting eye exams.

8. The device of embodiment 7, wherein said augmented realityhead-mounted ophthalmic system is configured to vary the focus of thefirst color component of the image automatically to provide incrementalchange in optical prescription thereby conducting eye exams.

9. The device of embodiment 8, wherein said augmented realityhead-mounted ophthalmic system is configured to vary the focus of amonochromatic image of said second color component automatically toprovide incremental change in optical prescription thereby conductingeye exams.

10. The device of embodiment 9, wherein said augmented realityhead-mounted ophthalmic system is configured to vary the focus of amonochromatic image of a third color component of the imageautomatically to provide incremental change in optical prescriptionthereby conducting eye exams.

11. The device of embodiment 10, wherein said images comprise letters.

12. The device of embodiment 10, wherein said images comprise graphicsymbols, pictures, or drawings.

13. The device of embodiment 7, further comprising a user interfaceconfigured to receive input from the wear regarding the image.

14. The device of embodiment 7, wherein said augmented realityhead-mounted ophthalmic system is configured to assess whether theperson can view the image comfortably and incrementally increase theprescription, positive or negative, by changing focus if not.

15. The device of any of embodiments any of embodiment 7, wherein saidaugmented reality head-mounted ophthalmic system is configured to assesswhether the person can view the image comfortably and determine theprescription of the person if so.

16. The device of embodiment 1, wherein said wearable augmented realitydisplay platform comprises a fiber scanning device.

17. The device of embodiment 1, wherein said wearable augmented realitydevice system is configured such that the angle at which light ofdifferent color is projected may be varied based lateral chromaticaberration.

18. The device of embodiment 1, wherein said optics comprises anadaptable optics element configured to project the light.

19. The device of embodiment 18, wherein the adaptable optics elementcomprises a variable focus element.

20. The device of any of embodiments any of embodiment 1, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

21. The device of embodiment 20, wherein the waveguide stack furthercomprises one or more lenses.

22. A wearable augmented reality device configured to be used by aperson, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a person wearing the head-mounted        system, said augmented reality display platform comprising        optics configured to project an image in said eye,    -   wherein said augmented reality display is configured to project        a first color component of the image at a first angle and a        second color component of the image at a second angle different        than the first angle to compensate for lateral chromatic        aberration of the person's eye.

23. The device of embodiment 22, further comprising a user interface forreceiving a prescription for said lateral chromatic aberration.

24. The device of any of embodiments 22, wherein said augmented realityhead-mounted ophthalmic system is configured to vary the angle of theimage automatically to provide incremental change in opticalprescription thereby conducting eye exams.

25. A wearable virtual reality device configured to be used by a person,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform comprising optics configured to project an        image in an eye of the person.    -   wherein said virtual reality display is configured to project a        first color image at a first depth plane and a second color        image at a second depth plane different than the first depth        plane to compensate for longitudinal chromatic aberration of the        person's eye.

26. A wearable virtual reality device configured to be used by a person,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        platform comprising optics configured to project an image in an        eye of the person,    -   wherein said virtual reality display is configured to project a        first color image at a first angle and a second color image at a        second angle different than the first angle to compensate for        lateral chromatic aberration of the person's eye.

27. The device of any of embodiments 1, further comprising one or moreoutwardly facing cameras configured to obtain an image, wherein saidimage projected into said eye comprises the obtained image.

28. The device of embodiment 17, wherein varying said angle at whichlight of different color is projected displaces an image formed by saidlight of different color along the focal plane of said optics.

29. The device of embodiment 17, wherein said optics comprises anadaptable optics configured to receive an input and vary the angle atwhich light of the first color component is projected based on lateralchromatic aberration.

30. A wearable device configured to be used by a person, said devicecomprising:

-   -   a head-mounted ophthalmic system comprising:        -   a display platform comprising optics configured to project            an image in said eye, and        -   a processor circuit configured to drive the optics based on            an image modification program, wherein said image            modification program is configured to compensate for            chromatic aberration imparted on to said image by an optical            surface.

31. The device of embodiment 30, wherein said head-mounted ophthalmicsystem further comprises a memory circuit operatively connected to theprocessor circuit and configured to store said image modificationprogram.

32. The device of embodiment 30, wherein said image modification programis based on an optical prescription of the person, wherein said opticalsurface comprises a surface of said eye.

33. The device of embodiment 30, wherein said image modification programis based on chromatic aberrations imparted on to said image by saidoptics, wherein said optical surface comprises a surface of said optics.

34. The device of embodiment 30, wherein said optics comprises avariable focus element, wherein the image modification program isconfigured to drive the variable focus element by selectively projectinga first color component of the image at a first depth plane and a secondcolor component of the image at a second depth plane different than thefirst depth plane to compensate for longitudinal chromatic aberrations.

35. A wearable device configured to be used by a person, said devicecomprising:

-   -   a head-mounted ophthalmic system comprising:        -   a memory circuit configured to store an image,        -   a display platform comprising optics configured to project            said image in an eye of the person, and        -   a processor circuit operatively coupled to the memory            circuit and configured to modify said image to compensate            for chromatic aberration in the person's eye.

36. The device of embodiment 35, wherein the processor is configured toapply an image modification program based on an optical prescription ofthe person.

37. A wearable device configured to be used by a person, said devicecomprising:

-   -   a head-mounted ophthalmic system comprising a display platform,        said display platform comprising optics configured to project an        image in an eye of the person,    -   wherein said display platform is configured to project a first        color component of the image at a first intensity and a second        color component of the image at a second intensity different        than the first intensity to compensate for chromatic aberration        of the person's eye.

38. The device of embodiment 37, wherein said chromatic aberrations ofthe person's eye causes said first color component to focus before aretina of said eye, wherein said first intensity is greater than saidsecond intensity.

39. The device of embodiment 37, wherein said chromatic aberrations ofthe person's eye causes said first color component to focus after aretina of said eye, wherein said first intensity is less than saidsecond intensity.

40. The device of embodiment 7, further comprising a biofeedback systemconfigured to provide an input to the augmented reality head-mountedophthalmic system, wherein the incremental change in the opticalprescription is based on the input.

41. The device of embodiment 7, further comprising a biofeedback systemconfigured to objectively monitor one or more properties of said eye,wherein the optical prescription is based on the monitored one or moreproperties.

42. The device of embodiment 41, wherein the biofeedback system receivesinputs from at least one of a phoropter, an auto-refractor, and an eyetracking system.

43. The device of embodiment 41, wherein the one or more properties ofsaid eye is at least one of: changes in a convergence point of the eye,changes in a position of a head of the person, change in a size of apupil of the eye.

44. The device of embodiment 24, further comprising a biofeedback systemconfigured to objectively monitor one or more properties of said eye,wherein the prescription is based on the monitored one or moreproperties of the eye.

45. The device of embodiment 32, further comprising a biofeedback systemconfigured to objectively monitor one or more properties of said eye,wherein the optical prescription is based on the monitored one or moreproperties of the eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Phoropter

1. A wearable augmented reality device configured to be used by a wearerhaving left and right eyes, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said augmented reality display platform optics        configured to project an image in said eye,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to vary the focus of the image automatically to        provide incremental changes in optical prescription thereby        conducting eye exams.

2. The device of embodiment 1, wherein said wearable augmented realitydisplay platform comprises a fiber scanning display.

3. The device of any of embodiments 1-2, wherein said optics comprisesan adaptable optics element configured to project the light.

4. The device of embodiment 3, wherein the adaptable optics elementcomprises a variable focus element.

5. The device of any of embodiments any of embodiments 1-4, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

6. The device of embodiment 5, wherein the waveguide stack furthercomprises one or more lenses.

7. The device of any of embodiments any of embodiments 1-6, wherein saidaugmented reality head-mounted ophthalmic system is configured toproject a variety of images of varying sizes and/or intensity.

8. The device of embodiments 7, wherein said images comprise letters.

9. The device of any of embodiments any of embodiments 1-8, furthercomprising a user interface configured to receive input from the wearregarding the image.

10. The device of any of embodiments any of embodiments 1-9, whereinsaid augmented reality head-mounted ophthalmic system is configured toassess whether the patient can view the image with normal visual acuityand to incrementally change the prescription, positive or negative, bychanging focus based on the assessment.

11. The device of any of embodiments any of embodiments 1-10, whereinsaid augmented reality head-mounted ophthalmic system is configured toassess whether the patient can view the image with normal visual acuityand to determine the prescription of the wearer based on the assessment.

12. The device of any of embodiments any of embodiments 1-11, whereinsaid augmented reality head-mounted ophthalmic system is configured toautomatically perform adjustments to the prescription based on physicalchanges of the eye.

13. The device of embodiment 12, wherein said augmented realityhead-mounted ophthalmic system is configured to track eye behavior suchthat adjustments may be automatically made by the ophthalmic system.

14. The device of any of embodiments 1-12, further comprising a fiberlight source, wherein said augmented reality head-mounted ophthalmicsystem varies the focus of the image by varying fiber length orposition.

15. The device of any of embodiments 1-12, further comprising amicroelectromechanical systems (MEMS) device, wherein said augmentedreality head-mounted ophthalmic system varies the focus of the image byvarying said MEMS device.

16. The device of any of embodiments 1-15, wherein the eye exams includevisual acuity exams, brightness tests, and/or glare tests.

17. The device of any of embodiments 1-16, wherein said augmentedreality head-mounted ophthalmic system is configured to automaticallydetermine a focus quality of the projected image.

18. The device of embodiment 17, wherein the focus quality of theprojected image is determined through analysis of accommodation,vergence, and/or pupil size of the eye of the wearer.

19. The device of any of embodiments any of embodiments 1-18, whereinsaid augmented reality head-mounted ophthalmic system is configured tomeasure accommodation reflex by measuring accommodation, vergence,and/or pupil size.

20. A wearable virtual reality device configured to be used by a wearerhaving left and right eyes, said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform optics configured to project an image in said        eye, wearable augmented reality display platform comprises a        fiber scanning display,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to vary the focus of the image automatically to        provide incremental change in optical prescription thereby        conducting eye exams.

21. A wearable virtual reality device configured to be used by a wearerhaving left and right eyes, said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform optics configured to project an image in said        eye, wearable augmented reality display platform comprises a        waveguide stack comprising a plurality of waveguides, wherein        different waveguides are configured to project light from        different depth planes,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to vary the focus of the image automatically to        provide incremental change in optical prescription thereby        conducting eye exams.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Red Reflex

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,        said eye comprising a retina and a cornea;    -   a light source configured to project light into the eye of the        wearer, at least a portion of said light reflecting from at        least a portion of said eye so as to produce a reflection; and    -   a camera configured to capture an image of the reflection, said        device being configured to perform a diagnostic test of the        wearer's eye to detect abnormalities of the eye.

2. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer, said eye comprising a        retina and a cornea;    -   a light source configured to project light into the eye of the        wearer, at least a portion of said light reflecting from at        least a portion of said eye so as to produce a reflection; and    -   a camera configured to capture an image of the reflection, said        device being configured to perform a diagnostic test of the        wearer's eye to detect abnormalities of the eye.

3. The device of embodiment 1 or 2, wherein said light source isconfigured to direct said light into said eye along the normal line ofsight of said eye.

4. The device of embodiment 1 or 2, wherein said light source isconfigured to direct said light into said eye at a first angle at afirst time and at a second different angle at a second time.

5. The device of embodiment 1 or 2, wherein said light source isconfigured to project said light to a first portion of the wearer's eyeat a first time and to project said light to a second different portionof the wearer's eye at a second time.

6. The device of embodiment 1 or 2, wherein the light source isconfigured to project light into two eyes of the wearer, each of the twoeyes comprising a retina and a cornea.

7. The device of embodiment 1 or 2, further comprising a second lightsource configured to project light into a second eye of the wearer, saidsecond eye comprising a second retina and a second cornea, at least aportion of said light reflecting from at least a portion of said secondeye so as to produce a reflection.

8. The device of any of embodiments 1-6, wherein said light sourcecomprises a display.

9. The device of embodiment 8, wherein said display comprises a fiberscanning display.

10. The device of embodiment 1 or 2, wherein said camera comprises aneye tracking camera.

11. The device of embodiment 1 or 2, further comprising an eye trackingcamera.

12. The device of embodiment 1 or 2, wherein said abnormality of the eyecomprises glaucoma, a cataract, cancer of the eye, retinoblastoma, adetached retina, aberrations of the eye, or corneal scarring.

13. The device of any of embodiments 1-12, wherein said light source isconfigured to project light into wearer's left and right eye.

14. The device of any of embodiments 1-13, wherein said camera isconfigured to capture an image of the reflection and to perform a redreflex test of the wearer's left and right eye.

15. The device of embodiment 13 or 14, wherein said abnormality of theeye comprises eye misalignment, strabismus, or asymmetry.

16. The device of embodiment 1 or 2, further comprising an adaptableoptics element.

17. The device of embodiment 16, wherein the adaptable optics elementcomprises a variable focus element.

18. The device of embodiment 16 or 17, wherein said adaptable opticselement is configured to direct said light into said eye at a firstangle at a first time and at a second different angle at a second time.

19. The device of embodiment 16 or 17, wherein said adaptable opticselement is configured to project said light to a first portion of thewearer's eye at a first time and to project said light to a seconddifferent portion of the wearer's eye at a second time.

20. The device of any of embodiments 1-19, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light as if from different depthplanes.

21. The device of embodiment 20, wherein the waveguide stack furthercomprises one or more lenses.

22. The device of embodiment 20 or 21, wherein the waveguide stack isconfigured to provide a fixation target for the wearer at differentdepth planes.

23. The device of any of embodiments 19-21, wherein the waveguide stackis configured to vary the depth plane of said fixation target therebycausing the wearer's eye to accommodate.

24. The device of any of embodiments 19-23, wherein said fixation targetis located away from the center of the wearer's field of view.

25. The device of embodiment 1 or 2, wherein at least one of saidwaveguides is configured to capture said image of the reflection.

26. The device of embodiment 25, wherein a plurality of said waveguidesare configured to capture a plurality of images of the reflection atdifferent depth planes.

27. The device of embodiment 26, wherein said at least one of saidwaveguides includes an optical element having optical power, saidoptical power corresponding to a depth plane of between 8 inches to 4feet from said eye.

28. The device of embodiment 1 or 2, wherein said display platform isconfigured to provide a first fixation target at a first location at afirst time and a second fixation target at a second different locationat a second time that causes the eye to move.

29. The device of any of embodiments 1-28, wherein said camera comprisesa light pipe.

30. The device of any of embodiments 1-29, wherein said light sourcecomprises a light pipe.

31. The device of any of embodiments 1-30, wherein said light comprisesvisible light.

32. The device of embodiment 31, wherein said light comprises whitelight.

33. The device of embodiment 32, further comprising at least onemechanical filter configured to limit the spectrum of reflected lightdetected at the camera.

34. The device of embodiment 32, wherein the device is configured todigitally filter images captured by the camera to remove light of atleast one wavelength range from the images.

35. The device of any of embodiments 1-32, wherein said light comprisesinfrared light.

36. The device of any of embodiments 1-33, wherein said at least aportion of said light reflects from said retina, and wherein saiddiagnostic test comprises a red reflex test.

37. The device of any of embodiments 1-313 wherein said at least aportion of said light reflects from said cornea, and wherein saiddiagnostic test comprises a Hirschberg comeal reflex test.

38. The device of any of embodiments 1-35, wherein said device isfurther configured to compare the results of said diagnostic test with adatabase of normal or abnormal results.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Intraocular Pressure

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said eye comprising a cornea, said augmented reality        head-mounted ophthalmic system configured to apply a force to        the cornea of said eye; and    -   a sensor configured to determine applanation of said cornea to        determine intraocular pressure of the eye.

2. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display        for providing images to the eye of the wearer, said eye        comprising a cornea, said virtual reality head-mounted        ophthalmic system configured to apply a force to the cornea of        said eye; and    -   a sensor configured to determine applanation of said cornea to        determine intraocular pressure of the eye.

3. The device of embodiment 1 or 2, wherein said head-mounted ophthalmicsystem is configured to apply a pulse of air to flatten the cornea.

4. The device of embodiment 1 or 2, wherein said head-mounted ophthalmicsystem is configured to apply mechanical force to the cornea of said eyethrough an eyelid of the wearer.

5. The device of embodiment 4, wherein said head-mounted ophthalmicsystem comprises a transducer.

6. The device of any of embodiments 1-4, wherein said sensor utilizesultrasonic range imaging.

7. The device of any of embodiments 1-4, wherein said sensor utilizesphotoacoustic imaging.

8. The device of any of embodiments 1-4, wherein said sensor comprisesan imaging head.

9. The device of embodiment 8, wherein said imaging head comprises aninterferometry 3D imaging head.

10. The device of any of embodiments 1-9, further comprising a lightsource configured to project beams of light into the wearer's eyes.

11. The device of any of embodiments 1-9, further comprising a fiberscanning display configured to project beams of light into the wearer'seyes.

12. The device of embodiment 10, further comprising an adaptable opticselement.

13. The device of embodiment 12, wherein the adaptable optics element isconfigured to project the light.

14. The device of embodiment 13, wherein the adaptable optics elementcomprises a variable focus element.

15. The device of any of embodiments 1-14, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light from different depth planes.

16. The device of embodiment 15, wherein the waveguide stack furthercomprises one or more lenses.

17. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system;    -   a light source configured to project light into the eye of the        wearer; and    -   a light-monitoring device configured to measure reflected light,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to determine intraocular pressure from said measured        reflected light.

18. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display        for providing images to the eye of the wearer,    -   a light source configured to project light into the eye of the        wearer; and    -   a light-monitoring device configured to measure reflected light,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to determine intraocular pressure from said measured        reflected light.

19. The device of embodiment 17 or 18, wherein said light sourcecomprises a fiber scanning display configured to project beams of lightinto the wearer's eyes.

20. The device of embodiment 19, wherein the fiber length of the fiberscanning display can be varied.

21. The device of embodiment 19, wherein said light-monitoring devicecomprises said fiber scanning display.

22. The device of embodiment 17 or 17, wherein said light-monitoringdevice comprises a fiber scanning display or photo-detectors.

23. The device of embodiment 17 or 18, wherein the wavelength of saidlight projected into said eye can be changed.

24. The device of embodiment 17 or 18, further comprising an adaptableoptics element configured to project the light into the wearer's eye.

25. The device of embodiment 24, wherein the adaptable optics elementcomprises a variable focus element.

26. The device of embodiment 17 or 18, further comprising a waveguidestack comprising a plurality of waveguides, wherein different waveguidesare configured to project light from different depth planes.

27. The device of embodiment 26, wherein the waveguide stack furthercomprises one or more lenses.

28. The device of any of embodiments 17-27, wherein the light-monitoringdevice is configured to measure backscattered light.

29. The device of any of embodiments 17-27, wherein the light-monitoringdevice is configured to detect on or more Purkinje images of thewearer's eye.

30. The device of embodiment 29, wherein the head-mounted ophthalmicsystem is configured to determine intraocular pressure at least in partbased on the shape or location of said one or more Purkinje images.

31. The device of embodiment 29 or 30, wherein said one or more Purkinjeimages comprises a glint.

32. The device of any of embodiments 1-31, wherein said ophthalmicsystem is further configured to detect the presence of ocularhypertension at least in part based on said determined intraocularpressure.

33. The device of any of embodiments 1-31, wherein said ophthalmicsystem is further configured to determine an ocular pulse rate at leastin part based on comparing a plurality of intraocular pressuresdetermined from measurements taken at a regular time interval.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Pinhole Occluder

1. A wearable augmented reality device configured to be used by aperson, said display device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into at least one eye of a person wearing the head-mounted        system;    -   a light source configured to project light into the eye of the        person to form an image in the eye; and    -   a user interface configured to receive input from a person,    -   wherein the wearable augmented reality device is configured to        occlude a particular portion of the person's eye and to receive        input from the person regarding the wear's vision through the        user interface.

2. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to occlude a central region.

3. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to occlude a peripheral region.

4. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to occlude the particular portion of the person'seye digitally.

5. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to occlude the particular portion of the person'seye manually.

6. A wearable virtual reality device configured to be used by a person,said display device comprising:

-   -   a head-mounted display comprising a virtual reality display        platform; and    -   a light source configured to project light into the eye of the        person to form an image in the eye, and    -   a user interface configured to receive input from a person,    -   wherein the wearable virtual reality device is configured to        occlude a particular portion of the person's eye and to receive        input from the person regarding the wear's vision through the        user interface.

7. The device of embodiment 6 wherein the wearable augmented realitydevice is configured to occlude a central region.

8. The device of embodiment 6, wherein the wearable augmented realitydevice is configured to occlude a peripheral region.

9. The device of embodiment 6, wherein an image is presented to theperson and the wearable virtual reality device is configured to receiveinput from the person regarding the image through the user interface.

10. A wearable display device configured to be used by a person, saiddisplay device comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of said        person to form an image in the eye;    -   a user interface configured to receive input from a person, and    -   an adaptable optics element configured to project the image to a        particular portion of the person's eye,    -   wherein the wearable display device is configured to occlude a        particular portion of the person's eye and to receive input from        the person regarding the wear's vision through the user        interface.

11. The device of embodiment 10, wherein the adaptable optics elementcomprises a variable focus element.

12. The device of embodiment 11, wherein the variable focus elementcomprises a membrane mirror.

13. The device of embodiment 12, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

14. A wearable display device configured to be used by a person, saiddisplay device comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into an eye of a        person to form an image in the eye, the light source comprising        a fiber scanning projector; and    -   a user interface configured to receive input from a person,    -   wherein the wearable display device is configured to occlude a        particular portion of the person's eye and to receive input from        the person regarding the wear's vision through the user        interface.

15. A wearable display device configured to be used by a person, saiddisplay device comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into one eye of said        person to form an image in the eye;    -   a waveguide stack comprising a plurality of waveguides, wherein        different waveguides are configured to project the light at        different focal planes; and    -   a user interface configured to receive input from a person,    -   wherein the wearable display device is configured to occlude a        particular portion of the person's eye and to receive input from        the person regarding the wear's vision through the user        interface.

16. The device of embodiment 15, wherein the waveguide stack furthercomprises one or more lenses.

17. The device of embodiment 15, wherein the head-mounted display systemcomprises an augmented reality head-mounted ophthalmic system configuredto pass light from the world into an eye of a person wearing thehead-mounted system.

18. A wearable augmented reality device configured to be used by aperson, said display device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a person wearing the head-mounted system;        and    -   a light source configured to project light into the eye of the        person to form an image in the eye,    -   wherein the wearable augmented reality device is configured to        occlude a particular portion of the person's eye.

19. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude a central region.

20. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude a peripheral region.

21. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude the particular portion of the person'seye digitally.

22. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude the particular portion of the person'seye manually.

23. The device of embodiment 1, wherein the augmented reality device isconfigured to obstruct a portion of the light corresponding to theparticular portion of the person's eye.

24. The device of embodiment 2, wherein occluding the central regionimproves the person's vision of the image, being indicative of a visualdefect in the eye of the person.

25. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude a particular portion of the person's eyebased on an optical prescription of the person.

26. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude a particular portion of the person's eyeby stopping down a peripheral portion of the light forming the image

27. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to adjust intensity of ambient light from the worldsurrounding the person.

28. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to occlude the particular portion of the eye basedon inputs from the world surrounding of the person.

29. The device of embodiment 28, wherein inputs from surroundingsincludes at least one of changes in gaze orientation, ambient light fromthe surroundings, and accommodation.

30. The device of embodiment 21, further comprising a waveguide stackcomprising a plurality of waveguides, wherein different waveguides areconfigured to project the light at different focal plane, whereindigitally occluding the particular portion of the eye comprisesselectively projecting light at different focal planes, wherein theparticular portion of the eye corresponds to a selected focal plane.

31. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to modify a color of a portion of the imagecorresponding to the particular portion of the eye.

32. The device of embodiment 18, wherein the wearable augmented realitydevice is configured to modify an intensity of a portion of the imagecorresponding to the particular portion of the eye.

33. The device of embodiment 9, further comprising a camera configuredto receive a reflected image based on the image presented to the personhaving passed through the particular portion of the person's eye andreflected by the retina of said eye, wherein the received input is basedon a comparison of the reflected image and an expected reflected image,the expected reflected image being based on a healthy eye.

34. The device of embodiment 14, wherein an image is presented to theperson and the wearable virtual reality device is configured to receiveinput from the person regarding the image through the user interface.

35. The device of embodiment 34, further comprising a camera configuredto receive a reflected image based on the image presented to the personhaving passed through the particular portion of the person's eye andreflected by the retina of said eye, wherein the received input is basedon a comparison of the reflected image and an expected reflected image,the expected reflected image being based on a healthy eye.

36. The device of embodiment 21, wherein the wearable augmented realitydevice is configured to modify a focus of a portion of the imagecorresponding to the particular portion of the eye.

37. The device of embodiment 21, wherein the wearable augmented realitydevice is configured to modify a contrast of a portion of the imagecorresponding to the particular portion of the eye relative to anotherportion of the image that does not correspond to the particular portionof the eye.

38. A wearable virtual reality device configured to be used by a person,said display device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform; and    -   a light source configured to project light into the eye of the        person to form an image in the eye.    -   wherein the wearable virtual reality device is configured to        occlude a particular portion of the person's eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Initial W4LT Test

1. A wearable augmented reality device configured to be used by a wearerhaving left and right eyes, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system; and    -   first and second displays included in said augmented reality        display platform for said left and right eyes respectively,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to project independent first and second images into        said left and right eyes respectively and to identify a vision        defect.

2. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to assess the wearer'sdegree of binocular vision and binocular single vision.

3. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to administer a Worth FourLight Test or a Worth Four Dot Test.

4. The device of embodiment 1, wherein said images comprise coloreddots.

5. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to detect suppression ofeither the right eye or the left eye.

6. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to receive input from thewearer, to analyze the received input, and to identify said visiondefect of the wearer.

7. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to project said independentfirst and second images from different depth planes.

8. The device of any of embodiments 1-7, further comprising a fiberscanning display configured to project light into the wearers eyes.

9. The device of any of embodiments 1-8, further comprising an adaptableoptics element configured to project the independent first and secondimages.

10. The device of embodiment 9, wherein the adaptable optics elementcomprises a variable focus element.

11. The device of any of embodiments 1-10, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light from different depth planes.

12. The device of embodiment 11, wherein the waveguide stack furthercomprises one or more lenses.

13. The device of any of embodiments 1-12, wherein said augmentedreality head-mounted ophthalmic system is configured to automaticallydetermine said vision defect of the wearer through analysis of theindependent first and second images as imaged on corresponding retinasof the wearer.

14. A wearable virtual reality device configured to be used by a wearerhaving left and right eyes, said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display        for providing images to an eye of the wearer; and    -   first and second displays included in said virtual reality        display platform for said left and right eyes respectively,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to project independent first and second images into        said left and right eyes respectively and to identify a vision        defect.

15. The device of embodiment 14, wherein said virtual realityhead-mounted ophthalmic system is configured to assess the wearersdegree of binocular vision and binocular single vision.

16. The device of embodiment 14, wherein said virtual realityhead-mounted ophthalmic system is configured to administer a Worth FourLight Test or a Worth Four Dot Test.

17. The device of embodiment 14, wherein said images comprise coloreddots.

18. The device of embodiment 14, wherein said virtual realityhead-mounted ophthalmic system is configured to detect suppression ofeither the right eye or the left eye.

19. The device of embodiment 14, wherein said virtual realityhead-mounted ophthalmic system is configured to receive input from thewearer, to analyze the received input, and to identify said visiondefect of the wearer.

20. The device of embodiment 14, wherein said virtual realityhead-mounted ophthalmic system is configured to project said independentfirst and second images from different depth planes.

21. The device of any of embodiments 14-20, further comprising a fiberscanning display configured to project light into the wearer's eyes.

22. The device of any of embodiments 14-21, further comprising anadaptable optics element configured to project the independent first andsecond images.

23. The device of embodiment 22, wherein the adaptable optics elementcomprises a variable focus element.

24. The device of any of embodiments 14-23, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light from different depth planes.

25. The device of embodiment 24, wherein the waveguide stack furthercomprises one or more lenses.

26. The device of any of embodiments 14-25, wherein said augmentedreality head-mounted ophthalmic system is configured to automaticallydetermine said vision defect of the wearer through analysis of theindependent first and second images as imaged on corresponding retinasof the wearer.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Retinoscopy

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,        said eye having a retina;    -   at least one light source configured to project light into the        eye of the wearer to form an image in the eye, said at least one        light source configured to sweep light across the retina of the        eye of the wearer producing a reflex of the retina; and    -   a sensor configured to measure a response of the retina to the        swept light such that said augmented reality head-mounted        ophthalmic system can perform retinoscopy to measure refractive        error of said eye.

2. The device of embodiment 1, wherein said image can be dynamicallymodified to provide dynamic retinoscopy.

3. The device of any of embodiments 1-2, wherein said at least one lightsource comprises a fiber scanning display.

4. The device of any of embodiments 1-3, wherein said at least one lightsource comprises a fiber scanning display and a light generating source.

5. The device of any of embodiments 1-4, further comprising an adaptableoptics element configured to project the image to a targeted portion ofthe wearer's eye.

6. The device of embodiment 5, wherein the adaptable optics elementcomprises a variable focus element.

7. The device of embodiment 6, wherein the variable focus elementcomprises a membrane mirror.

8. The device of embodiment 7 further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror based        on a corneal shape of the eye.

9. The device of any of embodiments any of embodiments 1-8, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

10. The device of embodiment 9, wherein the waveguide stack furthercomprises one or more lenses.

11. The device of any of embodiments any of embodiments 1-10, whereinthe wearable augmented reality device is configured to determine whetherthe measured refractive error has improved in response to a change inoptical power.

12. The device of embodiment any of embodiments 11, wherein the wearableaugmented reality device is configured to modify an applied opticalpower to reduce the measured refractive error.

13. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to perform retinoscopy to measure refractive error of        said eye.

14. A wearable virtual reality device configured to be used by a wearer,said device comprising: a virtual reality head-mounted ophthalmic systemcomprising a virtual reality display platform comprising a display forproviding images to an eye of the wearer, said eye having a retina;

-   -   at least one light source configured to project light into the        eye of the wearer to form an image in the eye, said at least one        light source configured to sweep light across the retina of the        eye of the wearer producing a reflex of the retina; and    -   a sensor configured to measure a response of the retina to the        swept light such that said virtual reality head-mounted        ophthalmic system can perform retinoscopy to measure refractive        error of said eye.

15. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to an eye of the wearer, said eye having a        retina;    -   wherein said virtual reality head-mounted ophthalmic system is        configured to perform retinoscopy to measure refractive error of        said eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Slit Lamp

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;    -   an optical source configured to project an illumination beam of        light into the eye of the wearer to illuminate an anterior or        posterior portion of the eye, a cross-sectional beam shape of        the illumination beam configured such that a dimension of the        cross-sectional beam shape along a superior-inferior direction        of the eye is greater than a dimension of the cross-sectional        beam shape along a nasal-temporal direction of the eye; and    -   an imaging system configured to capture an image of the        illuminated portion of the wearer's eye so as to perform a slit        lamp examination to determine health of said eye.

2. The device of embodiment 1, wherein the illumination beam from saidoptical source is incident on a location on the surface of the eye at anangle with respect to a normal to the surface of the eye at thelocation.

3. The device of embodiment 2, wherein the illumination beam from saidoptical source is incident on the location on the surface of the eye atan angle between about ±10-degrees and about ±90-degrees with respect tothe normal to the surface of the eye at the location.

4. The device of embodiment 2, wherein the illumination beam from saidoptical source is incident along an axis intersecting the eye andpassing through the pupil.

5. The device of embodiment 1, wherein the illumination beam from saidoptical source has a width along a temporal-nasal axis of the wearer'seye, wherein the width is between about 25 microns and about 1.0 mm

6. The device of embodiment 1, wherein the imaging system comprises acamera configured to track the wearer's eye.

7. The device of embodiment 1, wherein said device is further configuredto determine the health of the eye by matching a known pattern with theimage captured by the imaging system.

8. The device of embodiment 1, wherein said device is further configuredto compare the image captured by the imaging system with a previouslyobtained image of the eye.

9. The device of embodiment 1, wherein said light source comprises afiber scanning device.

10. The device of embodiment 1, further comprising an adaptable opticselement configured to project the illumination beam to a particularportion of the wearer's eye.

11. The device of embodiment 10, wherein the adaptable optics elementcomprises a variable focus element.

12. The device of embodiment 11, wherein the variable focus elementcomprises a membrane mirror.

13. The device of embodiment 12, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror.

14. The device of embodiment 10, wherein the adaptable optics element isconfigured to change the angle of incidence of the illumination beam atthe particular portion of the wearer's eye.

15. The device of embodiment 10, wherein the adaptable optics element isconfigured to change the width of the illumination beam.

16. The device of embodiment 10, wherein the adaptable optics element isconfigured to change the depth in the wearer's eye at which theillumination beam is focused.

17. The device of any of embodiments 1 to 17, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light from different focal planes.

18. The device of embodiment 17, wherein the waveguide stack furthercomprises one or more lenses.

19. The device of embodiment 1, wherein the illumination beam comprisesa thin sheet of light.

20. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;    -   a scanning fiber device configured to project light into the eye        of the wearer to illuminate the eye to perform a slit lamp        examination of the eye; and    -   a camera configured to capture an image of the illuminated        portion of the wearer's eye so as to determine health of said        eye.

21. The device of embodiment 20, wherein said fiber scanning device isconfigured to project an illumination beam into the eye of the wearer.

22. The device of embodiment 20, wherein the illumination beam has awidth along a nasal-temporal direction of the eye of the wearer, whereinthe width is between about 25 microns and about 1.0 mm

23. The device of embodiment 20, wherein the illumination beam has arectangular cross-sectional shape.

24. The device of embodiment 23, wherein a dimension of the rectangularcross-sectional shape along a superior-inferior direction of the eye isgreater than a dimension of the rectangular cross-sectional beam shapealong a nasal-temporal direction of the eye.

25. The device of embodiment 20, wherein said scanning fiber device isconfigured to project light into the eye of the wearer at a non-normalangle to the surface of the eye at the incidence location.

26. The device of embodiment 20, wherein said device is furtherconfigured to determine the health of the eye by matching a knownpattern with the image captured by the camera.

27. The device of embodiment 20, wherein said device is furtherconfigured to compare the image captured by the imaging system with apreviously obtained image of the eye.

28. The device of any of the embodiments, wherein said device isconfigured to detect changes in the wearer's eye at least twice a year.

29. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer;    -   an optical source configured to project an illumination beam of        light into the eye of the wearer to illuminate an anterior or        posterior portion of the eye, a cross-sectional beam shape of        the illumination beam configured such that a dimension of the        cross-sectional beam shape along a superior-inferior direction        of the eye is greater than a dimension of the cross-sectional        beam shape along a nasal-temporal direction of the eye; and    -   an imaging system configured to capture an image of the        illuminated portion of the wearer's eye so as to perform a slit        lamp examination to determine health of said eye.

30. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising an        virtual reality display platform comprising a display for        providing images to the eye of the wearer;    -   at scanning fiber device configured to project light into the        eye of the wearer to illuminate the eye to perform a slit lamp        examination of the eye; and    -   a camera configured to obtain an image of the illuminated        portion of the wearer's eye so as to determine health of said        eye.

31. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;    -   a light source configured to project a thin sheet of light into        the eye of the wearer to illuminate an anterior or posterior        portion of the eye; and    -   a camera configured to capture an image of the illuminated        portion of the wearer's eye so as to perform a slit lamp        examination to determine health of said eye.

32. The device of embodiment 21, wherein the sheet of light from saidoptical source is incident on a location on the surface of the eye at anangle with respect to a normal to the surface of the eye at thelocation.

33. The device of embodiment 21, wherein the sheet of light from saidoptical source has a width along a temporal-nasal axis of the wearer'seye, wherein the width is between about 25 microns and about 1.0 mm

34. The device of embodiment 21, wherein the camera is furtherconfigured to track the wearer's eye.

35. The device of embodiment 31, wherein said device is furtherconfigured to determine the health of the eye by matching a knownpattern with the image captured by the imaging system.

36. The device of embodiment 31, wherein said device is furtherconfigured to compare the image captured by the imaging system with apreviously obtained image of the eye.

37. The device of embodiment 31, wherein said light source comprises afiber scanning device.

38. The device of embodiment 31, further comprising an adaptable opticselement configured to project the thin sheet of light to a particularportion of the wearer's eye.

39. The device of embodiment 38, wherein the adaptable optics elementcomprises a variable focus element.

40. The device of embodiment 39, wherein the variable focus elementcomprises a membrane mirror.

41. The device of embodiment 31, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror.

42. The device of any of the embodiments above, wherein said cameracomprises a visible camera.

43. The device of any of the embodiments above, wherein said cameracomprises an infrared camera.

44. The device of any of the embodiments above, wherein said device isconfigured to detect changes in the wearer's eye at least twice a year.

45. The device any of the embodiments above, further comprising a frame,said display supported by said frame.

46. The device of Embodiment 45, wherein the optical source is disposedon the frame.

47. The device of Embodiments 45-46, wherein the imaging system isdisposed on the frame.

48. The device of Embodiments 45-47, wherein the frame includes one ormore ear stems.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Color Blindness

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform comprising a        display, said augmented reality head-mounted ophthalmic system        configured to pass light from the world into an eye of a wearer        wearing the head-mounted system, said wearable augmented reality        display platform comprising a display comprising at least one        light source,    -   wherein said wearable augmented reality device is configured to        administer a color test to test for deficiencies of the wearer        in detecting specific colors.

2. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform comprising a display,        said wearable virtual reality display platform comprising a        display comprising at least one light source,    -   wherein said wearable virtual reality device is configured to        administer a color test to test for deficiencies of the wearer        in detecting specific colors.

3. The device of embodiment 1 or 2, wherein said head-mounted ophthalmicsystem is configured such that said display provides images of Ishiharacolor plates.

4. The device of embodiment 1 or 2, wherein said head-mounted ophthalmicsystem is configured such that said display provides virtual images ofIshihara color plates.

5. The device of any of embodiments 1-4, wherein said head-mountedophthalmic system is configured to receive user input regarding saidcolor plates or color image.

6. The device of any of embodiments 1-5, wherein said head-mountedophthalmic system is configured to determine whether the wearer hasdefects based on the color test.

7. The device of embodiment 1 or 2, wherein said head-mounted ophthalmicsystem is configured to administer an anomaloscope test, saidhead-mounted ophthalmic system being configured to project light of acontrol color onto a first portion of said retina, and to project lightof variable color onto a second portion of said retina, said variablecolor being controllable by the wearer.

8. The device of any of embodiments 1-7, where said at least one lightsource comprises a fiber scanning display configured to project lightinto the wearer's eyes.

9. The device of any of embodiments 1-7, where said at least one lightsource comprises multiple fiber scanning displays configured to projectdifferent color light into the wearer's eyes.

10. The device of any of the above embodiments, where said head-mountedophthalmic system is configured to provide a background to enhance thevisibility of said color test.

11. The device of embodiment 10, wherein said background is providedusing one or more spatial light modulators configured to selectivelyattenuate light.

12. The device of any of the above embodiments, further comprising anadaptable optics element.

13. The device of embodiment 12, wherein the adaptable optics elementcomprises a variable focus element.

14. The device of any of the above embodiments, wherein said displaycomprises a waveguide stack comprising a plurality of waveguides,wherein the waveguide stack is configured to project light fromdifferent depth planes.

15. The device of embodiment 14, wherein said display is configured toproject Ishihara color plates at a plurality of depth planes.

16. The device of embodiment 14, wherein said display is configured toproject anomaloscope images at a plurality of depth planes.

17. The device of embodiment 14, wherein the waveguide stack furthercomprises one or more lenses.

18. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform and at least one        outward-facing camera configured to image light from the world,        said augmented reality head-mounted ophthalmic system configured        to pass said light from the world into an eye of a wearer        wearing the head-mounted system, said wearable augmented reality        display platform comprising a display comprising at least one        light source, said eye comprising a retina,    -   wherein said wearable augmented reality device is configured to        selectively modify said light from the world based on a color        detection deficiency of the wearer.

19. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform and at least one        outward-facing camera configured to image light from the world        and project said light from the world into an eye of a wearer        wearing the head-mounted system, said virtual reality        head-mounted virtual reality display platform comprising a        display comprising at least one light source, said eye        comprising a retina,    -   wherein said wearable virtual reality device is configured to        selectively modify said light from the world projected to the        eye based on a color detection deficiency of the wearer.

20. The device of embodiment 18 or 19, wherein said outward-facingcamera is configured to detect the presence in said light from the worldof a color for which the wearer has a detection deficiency.

21. The device of embodiment 20, wherein said selective modificationcomprises projecting light from the light source to increase theamplitude of said light in a region of the display comprising a colorfor which the wearer has a detection deficiency.

22. The device of embodiment 20, wherein said selective modificationcomprises changing the color of light in a region of the display.

23. The device of embodiment 22, wherein changing the color of light ina region of the display comprises using an optical filter to removespectral overlap between a plurality of photopigments.

24. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass said        light from the world into an eye of a wearer wearing the        head-mounted system, said wearable augmented reality display        platform comprising a display comprising at least one light        source,    -   wherein said wearable augmented reality device is configured to        selectively modify said light projected from the display based        on a color detection deficiency of the wearer.

25. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform system, said virtual        reality head-mounted virtual reality display platform comprising        a display comprising at least one light source,    -   wherein said wearable virtual reality device is configured to        selectively modify said light projected from the display to the        eye based on a color detection deficiency of the wearer.

26. The device of embodiment 24 or 25, wherein said selectivemodification comprises projecting light from the light source toincrease the amplitude of said light in a region of the displaycomprising a color for which the wearer has a detection deficiency.

27. The device of embodiment 24 or 25, wherein said selectivemodification comprises changing the color of light in a region of thedisplay.

28. The device of embodiment 24 or 25, wherein said selectivemodification comprises enhancing the color of light projected from atleast a portion of the display.

29. The device of embodiment 24, wherein said selective modificationcomprises decreasing the visibility of at least a portion of said lightfrom the world through destructive interference.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Ophthalmoscope/Funduscope

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to capture an image of an illuminated portion of the        wearer's eye for analysis to monitor health of the wearer's eye,        detect abnormalities of the eye or other health problems.

2. The device of embodiment 1, further comprising a fiber scanningdisplay configured to project a beam of light of a particular focus toat least one portion of the wearer's eye.

3. The device of embodiment 1, further comprising an eye trackingcameras for capturing said image of the illuminated portion of thewearer's eye.

4. The device of embodiment 2, wherein said fiber scanning display isconfigured to capture said image of the illuminated portion of thewearer's eye.

5. The device of embodiment 1, further comprising a specialized camerafor capturing said image of the illuminated portion of the wearer's eye.

6. The device of any one of embodiments 1-5, further comprising anelectronic hardware processor configured to analyze the captured imageto detect abnormalities of the eye or health problems.

7. The device of embodiment 6 wherein the electronic processor isconfigured to detect the abnormality of the eye by matching a knownpattern with the image.

8. The device of embodiment 6 wherein the electronic processor ispre-loaded with patterns indicative of health problems.

9. The device of any one of embodiments 1-8 wherein the electronichardware processor is remote from the augmented reality head-mountedophthalmic system.

10. The device of embodiment 1-10, further comprising an adaptableoptics element.

11. The device of embodiment 11, wherein the adaptable optics element isconfigured to project the beam of light to a particular portion of thewearer's eye.

12. The device of embodiment 11, wherein the adaptable optics elementcomprises a variable focus element.

13. The device of any of embodiments 1 to 13, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light as if originating fromdifferent focal planes.

14. The device of embodiment 13 wherein the waveguide stack furthercomprises one or more lenses.

15. The device of embodiment 1, wherein the fiber scanning is configuredto project the beam of light on a fundus of the wearer's eye.

16. The device of embodiment 1, wherein the projected beam of lightcomprises a white light.

17. The device of embodiment 1, wherein the projected beam of lightcomprises a colored light.

18. The device of embodiment 17, wherein the projected beam of light hasa wavelength in red, green or blue spectral region of the visiblespectrum of light.

19. The device of embodiment 1, wherein the projected beam of light isin a range of wavelengths in the infrared spectrum of light.

20. The device of embodiment 1, wherein the projected beam of light isconfigured to be focused at different depths in the wearer's eye.

21. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to capture an image of atleast a portion of the fundus of the wearer's eye.

22. The device of embodiment 21, wherein said augmented realityhead-mounted ophthalmic system is configured to capture an image of atleast a portion of the retina of the wearer's eye.

23. The device of embodiment 1, wherein said augmented realityhead-mounted ophthalmic system is configured to capture an image fromdifferent depths in the wearer's eye.

24. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;    -   a light source configured to project a beam of light to at least        one portion of the wearer's eye; and    -   a camera configured to capture an image of an illuminated        portion of the wearer's eye for analysis to monitor health of        the wearer's eye, detect abnormalities of the eye or other        health problems.

25. The device of embodiment 24, wherein said light source comprises afiber scanning device.

26. The device of embodiment 24, wherein said camera comprises eyetracking cameras.

27. The device of embodiment 24, wherein said camera comprises saidfiber scanning device.

28. The device of embodiment 24, further comprising an electronichardware processor configured to analyze the captured image to monitorhealth of the wearer's eye or detect the abnormality of the eye.

29. The device of embodiment 28, wherein the electronic hardwareprocessor is configured to analyze the captured image by matching aknown pattern, color, shape or size with the captured image.

30. The device of embodiment 29, wherein the electronic hardwareprocessor is pre-loaded with patterns indicative of health problems.

31. The device of embodiment 28, wherein the electronic hardwareprocessor is configured to compare the captured image with one or moreimages stored in an information store accessible by the electronichardware processor.

32. The device of embodiment 24 further comprising an adaptable opticselement.

33. The device of embodiment 32, wherein the adaptable optics element isconfigured to project the beam of light to a particular portion of thewearer's eye.

34. The device of embodiment 32, wherein the adaptable optics elementcomprises a variable focus element.

35. The device of any of embodiments 24 to 34, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light as if originating fromdifferent focal planes.

36. The device of embodiment 35, wherein the waveguide stack furthercomprises one or more lenses.

37. The device of embodiment 24, wherein the light source is configuredto project the beam of light on a fundus of the wearer's eye.

38. The device of embodiment 24, wherein the projected beam of lightcomprises a white light.

39. The device of embodiment 24, wherein the projected beam of lightcomprises a colored light.

40. The device of embodiment 39, wherein the projected beam of light hasa wavelength in red, green or blue spectral region of the visiblespectrum of light.

41. The device of embodiment 24, wherein the projected beam of lightincludes a range of wavelengths in the infrared spectrum of light.

42. The device of embodiment 24, wherein the projected beam of light isconfigured to be focused at different depths in the wearer's eye.

43. The device of embodiment 24, wherein said camera is configured tocapture an image of at least a portion of the fundus of the wearer'seye.

44. The device of embodiment 24, wherein said camera is configured tocapture an image from different depths in the wearer's eye.

45. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and    -   a fiber scanning display configured to project a beam of light        of a particular focus to at least one portion of the wearer's        eye,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to capture an image of an illuminated portion of the        wearer's eye for analysis to monitor health of the wearer's eye,        detect abnormalities of the eye or other health problems.

46. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer;    -   a light source configured to project a beam of light of a        particular focus to at least one portion of the wearer's eye;        and    -   an imaging system configured to capture an image of an        illuminated portion of the wearer's eye for analysis to monitor        health of the wearer's eye, detect abnormalities of the eye or        other health problems.

47. The device of any of the embodiments above, wherein the portion ofthe eye for which an image is captured by the device comprises thefundus.

48. The device of any of the embodiments above, wherein the portion ofthe eye for which an image is captured by the device comprises theretina.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Confocal Microscopy/SLO

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said augmented reality head-mounted ophthalmic system        comprising a confocal microscope configured to image the eye.

2. The device of embodiment 1, wherein said confocal microscopecomprises a light source.

3. The device of embodiment 2, wherein said light source comprises apoint source.

4. The device of embodiment 3, wherein the light source furthercomprises an aperture to form a point source.

5. The device of any of embodiments 2-4, wherein said light source isconfigured to project light beams of different wavelengths at differenttimes.

6. The device of embodiment 5, wherein said wavelengths include visiblewavelengths.

7. The device of embodiment 5, wherein said wavelengths include infraredwavelengths.

8. The device of any of embodiments 1-7, where said confocal microscopeis configured such that the angle at which light is projected by a lightsource onto the eye may be varied based on the portions of the eye spaceto be imaged.

9. The device of any of embodiments 1-8, wherein said confocalmicroscope comprises at least one pinhole aperture configured to passlight reflected from the eye.

10. The device of embodiment 9, wherein said confocal microscopecomprises at least one imaging optical element with optical power tofocus light reflected from said eye.

11. The device of embodiment 10, wherein said pinhole aperture isdisposed in an optical path between said imaging optical element andsaid optical detector.

12. The device of any of embodiments 9-11, wherein said pinhole apertureis disposed at the focus of said light reflected from said eye.

13. The device of any of embodiments 9-11, wherein said pinhole apertureis disposed at the focus of said imaging optical element.

14. The device of any of embodiments 1-13, wherein said confocalmicroscope comprises an optical detector.

15. The device of any of embodiments 1-14, wherein said confocalmicroscope comprises a fiber scanning device.

16. The device of embodiment 15, wherein said fiber scanning device isconfigured to project a light beam.

17. The device of any of embodiments 15-16, wherein said fiber scanningdevice is configured to receive light reflected from said eye.

18. The device of embodiment 17, wherein said fiber scanning deviceinclude an optical detector.

19. The device of any of embodiments 1-18, wherein said optics comprisesan adaptable optics element configured to project the light.

20. The device of embodiment 19, wherein the adaptable optics elementcomprises a variable focus element.

21. The device of any of embodiments any of embodiments 1-20, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

22. The device of embodiment 21, wherein the waveguide stack furthercomprises one or more lenses.

23. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform configured to project an image into an eye of        the wearer, said virtual reality head-mounted ophthalmic system        comprising a confocal microscope configured to image the eye.

24. The device of any of embodiments 1 and 3-23, wherein said confocalmicroscope comprises a scanning laser ophthalmoscope comprising a lightsource comprising a laser.

25. The device of any of the embodiments above, further comprising afluid delivery system configured to deliver a fluorescent dye.

26. The device of any of embodiments above, configured to visualize inreal time an image projected onto retina of the eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Two-Photon Microscopy

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said augmented reality head-mounted ophthalmic system        comprising a two-photon absorption microscope configured to        image the eye by producing two-photon absorption to generate        fluorescence.

2. The device of embodiment 1, wherein said two-photon absorptionmicroscope comprises a light source.

3. The device of embodiment 2, wherein said light source comprises alaser.

4. The device of embodiment 3, wherein said laser comprises apico-second laser configured to output picosecond pulses.

5. The device of embodiment 3, wherein said laser comprises afemto-second laser configured to output femto-second pulses.

6. The device of embodiment 3, wherein said laser comprises amode-locked laser.

7. The device of embodiment 3, wherein said laser comprises a fiberlaser.

8. The device of embodiment 2, wherein light source is configured tooutput infrared wavelengths.

9. The device of embodiment 8, wherein light source is configured tooutput infrared light having a wavelength between 700-1000 nm.

10. The device of any of embodiments 1-9, further comprising an opticalelement with optical power configured to focus the light onto the eye.

11. The device of any of embodiments 1-10, where said two-photonabsorption microscope is configured such that the angle at which lightis projected by a light source onto the eye may be varied based on theportions of the eye to be imaged.

12. The device of any of embodiments 1-11, further comprising a scannerconfigured to scan a beam of light onto said eye.

13. The device of any of embodiments 1-12, wherein said two-photonabsorption microscope comprises an optical detector.

14. The device of any of embodiments 1-13, wherein said two-photonabsorption microscope comprises a fiber scanning device.

15. The device of embodiment 14, wherein said fiber scanning device isconfigured to project a light beam.

16. The device of any of embodiments 14-15, wherein said fiber scanningdevice is configured to receive light reflected from said eye.

17. The device of embodiment 16, wherein said fiber scanning deviceinclude an optical detector.

18. The device of any of embodiments 1-17, further comprising anadaptable optics element configured to project the light.

19. The device of embodiment 18, wherein the adaptable optics elementcomprises a variable focus element.

20. The device of any of embodiments any of embodiments 1-19, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

21. The device of embodiment 20, wherein the waveguide stack furthercomprises one or more lenses.

22. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said augmented reality head-mounted ophthalmic system        comprising a multi-photon absorption microscope configured to        image the eye by producing multi-photon absorption to generate        fluorescence.

23. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform configured to project an image into an eye of        the wearer, said virtual reality head-mounted ophthalmic system        comprising a two-photon absorption microscope configured to        image the eye.

24. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform configured to project an image into an eye of        the wearer, said virtual reality head-mounted ophthalmic system        comprising a multi-photon absorption microscope configured to        image the eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Autorefractor

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,        said eye having a retina,    -   wherein said augmented reality head-mounted ophthalmic system is        configured to capture images of the retina and determine when        the one or more images formed by said fiber scanning display is        on the retina to determine an optical prescription for the        wearer.

2. The device of embodiment 1, further comprising a fiber scanningdisplay configured to provide the one or more images at varying depth.

3. The device of embodiment 2, further comprising an adaptable opticselement configured to provide the one or more images at varying depth.

4. The device of embodiment 3, wherein the adaptable optics elementcomprises a variable focus element.

5. The device of embodiment 4, wherein the variable focus elementcomprises a membrane mirror.

6. The device of embodiment 5, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror.

7. The device of any of embodiments 1 to 6, further comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light from different focal planes.

8. The device of embodiment 7, wherein the waveguide stack furthercomprises one or more lenses.

9. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer, said eye having a        retina; and    -   a fiber scanning display configured to provide one or more        images at varying depth,    -   wherein said virtual reality head-mounted ophthalmic system is        configured to capture images of the retina and determine when        the one or more images formed by said fiber scanning display is        on the retina to determine an optical prescription for the        wearer.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

OCT

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        wearable augmented reality display platform, said augmented        reality head-mounted ophthalmic system configured to pass light        from the world into an eye of a wearer wearing the head-mounted        system, said augmented reality display comprising an optical        coherence tomography system configured to image the eye.

2. The device of embodiment 1, wherein said optical coherence tomographysystem is configured to project light beams of varying wavelengths.

3. The device of embodiment 2, wherein said wavelengths include visiblewavelengths.

4. The device of embodiment 2, wherein said wavelengths include infraredwavelengths.

5. The device of any of embodiments 1-4, wherein said wearable augmentedreality display platform comprises a 3D scanning head comprising a fiberscanning device.

6. The device of embodiment 5, wherein said fiber scanning device isconfigured to project light beams into the eye.

7. The device of embodiment 5, wherein said fiber scanning device isconfigured to receive light from the eye.

8. The device of any of embodiments 1-7, further comprising an eyetracking system configured to measure eye movement to de-noise theoptical coherence tomography images.

9. The device of any of embodiments 1-7, further comprising ERG.

10. The device of any of embodiments 1-9, where said optical coherencetomography system is configured such that the angle at which light isprojected by a light source may be varied based on the regions of theeye space to be imaged.

11. The device of any of embodiments 1-10, further comprising one ormore inward facing cameras configured to receive light from the eye.

12. The device of embodiment 11, wherein the one or more inward facingcameras comprise at least one CMOS sensor.

13. The device of any of embodiments 1-10, further comprising aplurality of photodetectors positioned at different parts of the system.

14. The device of embodiment 12, wherein said photodetectors may bepositioned around a rim of the head-mounted ophthalmic system.

15. The device of embodiment 12, wherein said photodetectors may bepositioned around the periphery of a frame of the head-mountedophthalmic system.

16. The device of any of embodiments 1-14, wherein said optics comprisesan adaptable optics element configured to project light.

17. The device of embodiment 15, wherein the adaptable optics elementcomprises a variable focus element.

18. The device of any of embodiments any of embodiments 1-16, furthercomprising a waveguide stack comprising a plurality of waveguides,wherein different waveguides are configured to project light fromdifferent depth planes.

19. The device of embodiment 17, wherein the waveguide stack furthercomprises one or more lenses.

20. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        wearable virtual reality display platform, said virtual reality        display platform configured to project an image into an eye of        the wearer, said virtual reality display comprising a optical        coherence tomography system configured to image the eye,    -   wherein wearable virtual reality display platform comprises a        fiber scanning device.

21. A wearable virtual reality device configured to be used by a wearer,said device comprising: a virtual reality head-mounted ophthalmic systemcomprising a wearable augmented reality display platform, said virtualreality display platform configured to project an image into an eye ofthe wearer, said virtual reality display comprising an optical coherencetomography system configured to image the eye,

-   -   wherein said wearable virtual reality display platform comprises        a waveguide stack comprising a plurality of waveguides, wherein        different waveguides are configured to project light from        different depth planes.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Aberrometer

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,        said eye having a cornea, lens, and retina;    -   at least one light source and wearable optics configured to        produce a wavefront and project the wavefront into the eye of        the wearer so as to pass through the cornea and lens of the eye        and be reflected back by the retina of the eye; and    -   an aberrometer configured to measure the wavefront that passes        through the eye to determine abnormalities of the eye.

2. The device of embodiment 1, wherein said at least one light sourcecomprises a fiber scanning display.

3. The device of embodiment 1, wherein said at least one light source isconfigured to produce a desired wavefront.

4. The device of embodiment 1, wherein said at least one light source isconfigured to produce wavefronts of different wavelengths.

5. The device of embodiment 4, wherein said at least one light source isconfigured to produce visible wavefronts that are projected into theeye.

6. The device of embodiment 4, wherein said at least one light source isconfigured to produce invisible wavefronts that are projected into theeye.

7. The device of embodiment 1, wherein said wearable optics compriseadaptive optics configured to be adjusted to implement the correction.

8. The device of embodiment 7, wherein the adaptive optics comprises avariable focus element.

9. The device of embodiment 7, wherein the adaptive optics comprises adeformable optical element.

10. The device of embodiment 9, wherein the deformable optical elementcomprises a deformable mirror.

11. The device of embodiment 1, wherein said wearable optics comprise awaveguide stack comprising a plurality of waveguides configured toprovide different focal planes.

12. The device of embodiment 11, wherein the waveguide stack isconfigured to configured to produce a desired wavefront.

13. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer, said eye having a        cornea, lens, and retina;    -   at least one light source and wearable optics configured to        produce a wavefront and project the wavefront into the eye of        the wearer so as to pass through the cornea and lens of the eye        and be reflected back by the retina of the eye; and    -   an aberrometer configured to measure the wavefront that passes        through the eye to determine abnormalities of the eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Ultrasound

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform comprising a display        configured for forming an image viewable by said wearer, said        augmented reality head-mounted ophthalmic system configured to        pass light from the world into an eye of a wearer wearing the        head-mounted system; and    -   an ultrasound producing component comprising an ultrasound        transducer included with said augmented reality head-mounted        ophthalmic system so as to deliver ultrasound to the user's eye        so as to create an ultrasound image.

2. The device of embodiment 1, wherein said wearable augmented realitysystem is configured to detect eye abnormalities or monitor health ofthe user's eye from the created ultrasound image.

3. The device of embodiment 2, further comprising a processor configuredwith a pattern match algorithm to detect eye abnormalities.

4. The device of embodiment 1, wherein said ultrasound producingcomponent is configured to deliver ultrasound based on a protocol forsaid user.

5. The device of embodiment 1, further comprising an adaptable opticselement configured to project the image to a particular portion of thewearer's eye.

6. The device of embodiment 5, wherein the adaptable optics elementcomprises a variable focus element.

7. The device of embodiment 6, wherein the variable focus elementcomprises a membrane mirror.

8. The device of embodiment 7, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror.

9. The device of embodiment 1, further comprising a light source forforming said images in said eye of the wearer, said light sourcecomprising a fiber scanning projector.

10. The device of embodiment 1, wherein said display comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light at different focal planes.

11. The device of embodiment 10, wherein the waveguide stack furthercomprises one or more lenses.

12. The device of embodiments 1-11, wherein the ultrasound producingcomponent comprises a probe configured to deliver ultrasound energy tothe eye and receive ultrasound energy from the eye.

13. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform comprising a display        configured for forming an image viewable by said wearer, said        augmented reality head-mounted ophthalmic system configured to        pass light from the world into an eye of a wearer wearing the        head-mounted system; and    -   an ultrasound producing component comprising an ultrasound        transducer coupled to said augmented reality head-mounted        ophthalmic system so as to deliver ultrasound to the user's eye        so as to create an ultrasound image so that abnormalities of the        eye can be detected,    -   wherein said wearable augmented reality device is configured to        measure a response of the user's eye to said ultrasound to        detect eye abnormalities.

14. The device of embodiment 13, wherein said abnormality includes adetached retina.

15. The device of embodiment 13, further comprising an adaptable opticselement configured to project the image to a particular portion of thewearer's eye.

16. The device of embodiment 13, wherein the adaptable optics elementcomprises a variable focus element.

17. The device of embodiment 16, wherein the variable focus elementcomprises a membrane mirror.

18. The device of embodiment 17, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror.

19. The device of embodiment 13, further comprising a light source forforming said images in said eye of the wearer, said light sourcecomprising a fiber scanning projector.

20. The device of embodiment 13, wherein said display comprising awaveguide stack comprising a plurality of waveguides, wherein differentwaveguides are configured to project light at different focal planes.

21. The device of embodiment 20, wherein the waveguide stack furthercomprises one or more lenses.

22. The device of embodiments 13-21, wherein the ultrasound producingcomponent comprises a probe configured to deliver ultrasound energy tothe eye and receive ultrasound energy from the eye.

23. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and    -   an ultrasound producing component comprising an ultrasound        transducer coupled to said virtual reality head-mounted        ophthalmic system so as to deliver ultrasound to the user's eye        so as to create an ultrasound image.

24. The device of Embodiments 21, configured to detect abnormalities ofthe eye from the created ultrasound image.

25. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and    -   an ultrasound producing component comprising an ultrasound        transducer coupled to said virtual reality head-mounted        ophthalmic system so as to deliver ultrasound to the user's eye        so as to create an ultrasound image so that abnormalities of the        eye can be detected,    -   wherein said wearable virtual reality device is configured        measure a response of the user's eye to said ultrasound.

26. The device of Embodiments 22, configured to detect abnormalities ofthe eye from the measured response.

27. The device of any of the embodiments above, wherein the device isconfigured to auscultation.

28. The device of any of the embodiments above, wherein the device isconfigured to transmit or receive ultrasound energy to or from the eyein audible frequency range.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Electrooculography (EOG), Electroencephalography (EEG), andElectroretinography (ERG)

1. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform comprising a display, said        augmented reality head-mounted ophthalmic system configured to        pass light from the world into an eye of a wearer wearing the        head-mounted system;    -   a plurality of electrodes configured to be placed around the        eye,    -   wherein said wearable augmented reality device is configured to        measure and compare resting electrical potentials of the retina.

2. The device of embodiment 1, wherein the electrodes compriseelectrooculography (EOG) sensors.

3. The device of embodiment 2, further comprising electroencephalography(EEG) sensors.

4. The device of embodiment 1, further comprising a camera configured tooptically image the eye.

5. The device of embodiment 1, further comprising an adaptable opticselement configured to project the image to a particular portion of thewearer's eye.

6. The device of embodiment 6, wherein the adaptable optics elementcomprises a variable focus element.

7. The device of embodiment 7, wherein the variable focus elementcomprises a membrane mirror.

8. The device of embodiment 8, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror based on a cornealshape of the eye.

9. The device of embodiment 1, wherein the light source comprising afiber scanning projector.

10. The device of embodiment 1, further comprising a waveguide stackcomprising a plurality of waveguides, wherein different waveguides areconfigured to project light at different focal planes.

11. The device of embodiment 11, wherein the waveguide stack furthercomprises one or more lenses.

12. A wearable augmented reality device configured to be used by awearer, said device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform comprising a display, said        augmented reality head-mounted ophthalmic system configured to        pass light from the world into an eye of a wearer wearing the        head-mounted system; and    -   a plurality of electroencephalography (EEG) sensors configured        to map brain activity,    -   wherein said wearable augmented reality device is configured        detect abnormal activity or pattern in the brain of the wearer.

13. The device of embodiment 12, further comprising an adaptable opticselement configured to project the image to a particular portion of thewearer's eye.

14. The device of embodiment 13, wherein the adaptable optics elementcomprises a variable focus element.

15. The device of embodiment 14, wherein the variable focus elementcomprises a membrane mirror.

16. The device of embodiment 15, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror based on a cornealshape of the eye.

17. The device of embodiment 12, wherein the light source comprising afiber scanning projector.

18. The device of embodiment 12, further comprising a waveguide stackcomprising a plurality of waveguides, wherein different waveguides areconfigured to project light at different focal planes.

19. The device of embodiment 18, wherein the waveguide stack furthercomprises one or more lenses.

20. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising an        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and    -   a plurality of electrodes configured to be placed around the        eye,    -   wherein said wearable virtual reality device is configured to        measure and compare resting electrical potentials of the retina.

21. A wearable virtual reality device configured to be used by a wearer,said device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising an        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and    -   a plurality of electroencephalography (EEG) sensors configured        to map brain activity, wherein said wearable virtual reality        device is configured detect abnormal activity or pattern in the        brain of the wearer.

22. The device of embodiment 1, wherein said electrodes are disposed onsaid augmented reality head-mounted ophthalmic system around the wear'seye.

23. The device of embodiment 1 or 20, wherein the electrodes compriseelectroretinography (ERG) sensors.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Light Therapy

1. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;        and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,    -   wherein the wearable augmented reality device is configured to        detect an amount of one or more wavelengths of light directed        towards the eye and to modify the amount of the one or        wavelengths of light reaching the eye based on the detected        amount.

2. The device of embodiment 1, wherein the head-mounted system isconfigured to actively reduce the amount of light of one or morewavelengths reaching the eye.

3. The device of embodiment 2, wherein the head-mounted system isconfigured to actively reduce the amount of light of one or morewavelengths by reducing the amount of light of one or more wavelengthsprojected by the light source to the eye.

4. The device of embodiment 3, wherein the head-mounted system isconfigured to:

-   -   provide instructions for the amount of light of the one or more        wavelengths to be outputted by the light source; and    -   subsequently modify the instructions to reduce an output of the        light of the one or more wavelengths by the light source.

5. The device of embodiment 2, wherein the head-mounted system isconfigured to:

-   -   block at least a portion of the wearer's view of the world,        thereby reducing the amount of the one or more wavelengths of        light reaching the eye from the world,    -   wherein a size and location of the portion of the wearer's view        of the world that is blocked is determined based on the detected        amount of the one or more wavelengths of the light.

6. The device of embodiment 1, further comprising one or more sensorsconfigured to detect an amount of the one or more wavelengths of lightincident on the head-mounted system.

7. The device of embodiment 6, wherein the one or more sensors is acamera attached to the head-mounted system.

8. The device of embodiment 6, wherein the one or more sensors isconfigured to detect an overexposure of light of a particular color,wherein the head-mounted system is configured to reduce an mount of thelight of the particular color reaching the eye.

9. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to selectively reduce blue light reaching the eye.

10. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to modify the amount of the one or wavelengths oflight reaching the eye based on the detected amount and based on a timeof day.

11. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to modify the amount of the one or wavelengths oflight reaching the eye based on the detected amount and based on acalendar date.

12. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to modify the amount of the one or wavelengths oflight reaching the eye based on the detected amount and based on acurrent season and location of the wearer.

13. The device of embodiment 1, further comprising an adaptable opticselement configured to project the image to a particular portion of thewearer's eye.

14. The device of embodiment 13, wherein the adaptable optics elementcomprises a variable focus element.

15. The device of embodiment 14, wherein the variable focus elementcomprises a membrane mirror.

16. The device of embodiment 15, further comprising:

one or more electrodes coupled to the membrane mirror; anda control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror.

17. The device of embodiment 14, wherein the light source comprising afiber scanning projector.

18. The device of embodiment 1, further comprising a waveguide stackcomprising a plurality of waveguides, wherein different waveguides areconfigured to project light at different focal planes.

19. The device of embodiment 18, wherein the waveguide stack furthercomprises one or more lenses.

20. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;        and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye.    -   wherein the wearable augmented reality device is configured to        selectively administer light of a portion of a light spectrum        into the wearer's eyes.

21. The device of embodiment 20, further comprising one or more sensorsconfigured to detect the under exposure of light of the portion of thelight spectrum, wherein the wearable augmented reality device isconfigured to selectively augment the light based on the detected underexposure.

22. The device of embodiment 20, further comprising one or more sensorsconfigured to detect an underexposure of blue light.

23. The device of embodiment 22, wherein the wearable augmented realitydevice is configured to selectively administer blue light.

24. The device of embodiment 20, wherein the light comprises a range ofwavelengths corresponding to daylight.

25. The device of embodiment 20, wherein the light comprises a range ofwavelengths corresponding to full spectrum light.

26. The device of embodiment 20, further comprising a second lightsource configured to provide the light to be selectively administered tothe wearer's eyes.

27. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;        and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,    -   wherein the wearable augmented reality device is configured to        selectively administer light of a predefined range of        wavelengths into the wearer's eyes based on a treatment        protocol.

28. The device of embodiment 27, wherein the treatment protocol is toadminister a prescribed amount of the light periodically.

29. The device of embodiment 27, wherein the treatment protocol is toadminister a prescribed amount of the light continuously.

30. The device of embodiment 27, wherein the wearable augmented realitydevice is configured to modify the predefined range of wavelengths basedon a time of day.

31. The device of embodiment 27, wherein the wearable augmented realitydevice is configured to modify the predefined range of wavelengths basedon a calendar date.

32. The device of embodiment 27, wherein the wearable augmented realitydevice is configured to modify the predefined range of wavelengths basedon a current season and/or location of the wearer.

33. The device of embodiment 27, wherein the wearable augmented realitydevice is configured to determine a treatment protocol for selectivelyadministering the light of the certain portion of the spectrum into thewearer's eyes.

34. The device of embodiment 33, wherein the wearable augmented realitydevice is configured to determine the treatment protocol based on one ormore of the following: a physiological state of the wearer, a mood ofthe wearer, and an ambient environment around the wearer.

35. The device of embodiment 33, wherein the wearable augmented realitydevice is configured to determine the treatment protocol based on inputfrom the wearer.

36. The device of embodiment 33, wherein the wearable augmented realitydevice is configured to determine the treatment protocol based on a signof depression or other abnormality of the wearer.

37. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a reality head-mounted ophthalmic system comprising a virtual        reality display platform; and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,    -   wherein the wearable virtual reality device is configured to        selectively remove light of a particular color.

38. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising an        virtual reality display platform; and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,    -   wherein the wearable virtual reality device is configured to        detect an underexposure of light within a certain portion of the        spectrum and to selectively administer light of the certain        portion of the spectrum into the wearer's eyes.

39. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform; and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,        wherein the wearable virtual reality device is configured to        selectively administer light of the certain portion of the        spectrum into the wearer's eyes based on a treatment protocol.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Macular Degeneration

1. A wearable augmented reality device configured to be used by awearer, said display device comprising:

an augmented reality head-mounted ophthalmic system comprising anaugmented reality display platform, said augmented reality head-mountedophthalmic system configured to pass light from the world into an eye ofa wearer wearing the head-mounted system;

a light source configured to project light into the eye of the wearer toform an image in the eye; and

a user interface configured to receive input from a user,

wherein the wearable augmented reality device is configured to projectthe image to a particular portion of the wearer's eye and to detect aresponse regarding the image to determine the health of that portion ofthe eye.

2. A wearable virtual reality device configured to be used by a wearer,said display device comprising:

a head-mounted display comprising a virtual reality display platform;and

a light source configured to project light into the eye of the wearer toform an image in the eye, and

a user interface configured to receive input from a user,

-   -   wherein the wearable virtual reality device is configured to        project the image to a particular portion of the wearer's eye        and to detect a response regarding the image to determine the        health of that portion of the eye.

3. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

a head-mounted ophthalmic system;

a light source configured to direct light into an eye of said wearer toform an image in the eye;

a user interface configured to receive input from a user, and

an adaptable optics element configured to receive, from the lightsource, light that is directed to the eye;

wherein said wearable augmented reality device is configured to detect aresponse regarding the image to determine the health of that portion ofthe eye.

4. The device of embodiment 3, wherein the adaptable optics elementcomprises a variable focus element.

5. The device of embodiment 4, wherein the variable focus elementcomprises a membrane mirror.

6. The device of embodiment 5, further comprising:

one or more electrodes coupled to the membrane mirror; and

a control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror.

7. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

a head-mounted display system; and

a light source configured to direct light into an eye of a wearer toform an image in the eye, the light source comprising a fiber scanningprojector; and

a user interface configured to receive input from a user,

wherein the wearable display device is configured to project the imageto a particular portion of the wearer's eye and to detect a responseregarding the image to determine the health of that portion of the eye.

8. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

a head-mounted display system; and

a light source configured to direct light into one eye of said wearer toform an image in the eye;

a waveguide stack comprising a plurality of waveguides; and

a user interface configured to receive input from a user,

wherein the wearable display device is configured to project the imageto a particular portion of the wearer's eye and to detect a responseregarding the image to determine the health of that portion of the eye.

9. The device of embodiment 8, wherein the waveguide stack furthercomprises one or more lenses.

10. The device of embodiment 8, wherein the head-mounted display systemcomprises an augmented reality head-mounted ophthalmic system configuredto pass light from the world into an eye of a wearer wearing thehead-mounted system.

11. The device of any of embodiments 1-10, wherein the wearable deviceis configured to project the image to another portion of the wearer'seye and to detect a response regarding the image to determine the healthof that portion of the eye.

12. The device of any of embodiments 1-10, wherein the wearable deviceis configured to project a first image and a second image to the sameportion of the wearer's eye, to detect a response regarding each image,and to compare the first response to the second response to determinethe health of that portion of the eye.

13. The device of embodiment 12, wherein at least one hue present in thefirst image is different from at least one hue present in the secondimage.

14. The device of embodiment 13, wherein said wearable augmented realitydevice is configured to identify areas of reduced color sensitivitybased on the portions of the eye tested.

15. The device of embodiment 11, wherein said wearable augmented realitydevice is configured to determine the location of macular degenerationbased on the portions of the eye tested.

16. The device of embodiment 15, wherein determining the location ofmacular degeneration is further based on imaging of a retina of the eyeof the wearer.

17. The device of embodiment 11, wherein said wearable augmented realitydevice is configured to identify anomalies in the wearer's eye based onthe portions of the eye tested.

18. The device of embodiment 11, wherein said determining the health ofa portion of the eye is performed in real time.

19. The device of embodiment 11, wherein said wearable augmented realitydevice is further configured to store data regarding the projectedimages and the detected responses, and wherein said determining thehealth of a portion of the eye is performed at a later time based on thestored data.

20. The device of embodiment 19, wherein said wearable augmented realitydevice is further configured to transmit the stored data, and whereinsaid determining the health of a portion of the eye is performedremotely based on the transmitted data.

21. The device of any of embodiments 1-10, wherein detecting a responsecomprises receiving an input from the user through the user interface.

22. The device of any of embodiments 1-10, wherein detecting a responsecomprises detecting a movement of the eye of the wearer.

23. The device of embodiment 22, wherein said movement of the eye of thewearer is a voluntary response to the image.

24. The device of embodiment 23, wherein said movement of the eye of thewearer is an involuntary response to the image.

25. The device of any of embodiments 1-10, further comprising a displayfor forming the image in the eye of the wearer.

26. The device of embodiment 25, wherein the display comprises a fiberscanning display.

27. The device of any of embodiments 25 or 26, wherein the displayfurther comprises a waveguide stack.

28. The device of any of embodiments 25, 26, or 27, wherein the displayis configured to produce images at multiple depth planes.

29. A wearable augmented reality device configured to be used by awearer, said display device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising a        augmented reality display platform, said augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system;        and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye,    -   wherein the wearable device is configured to selectively project        pixels of an image to healthy cells.

30. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into an eye of a        wearer to form an image in the eye, the light source comprising        a fiber scanning projector,    -   wherein the light source is configured to selectively project        pixels of an image to healthy cells.

31. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

-   -   a head-mounted display system; and    -   a light source configured to direct light into one eye of said        wearer to form an image in the eye; and    -   a waveguide stack comprising a plurality of waveguides,    -   wherein the wearable display device is configured to selectively        project pixels of an image to healthy cells.

32. The device of embodiment 31, wherein the waveguide stack furthercomprises one or more lenses.

33. The device of embodiment 31, wherein the head-mounted display systemcomprises an augmented reality head-mounted ophthalmic system configuredto pass light from the world into an eye of a wearer wearing thehead-mounted system.

34. The device of any of Embodiments 29-33, wherein the wearable deviceis configured to selectively project pixels of an image to healthy cellsat the periphery of the retina.

35. The device of any of Embodiments 29-33, wherein the wearable deviceis configured to selectively project a portion of the image to healthycells.

36. The device of any of Embodiments 29-33, wherein the wearable deviceis configured to alter the light projected to the eye.

37. The device of Embodiment 36, wherein the wearable device isconfigured to magnify or brighten pixels of the image projected todamaged areas of the eye.

38. A wearable virtual reality device configured to be used by a wearer,said display device comprising:

-   -   a head-mounted display comprising a virtual reality display        platform; and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye.    -   wherein the wearable device is configured to selectively project        pixels of an image to healthy cells.

39. The device of Embodiment 38, wherein the wearable device isconfigured to selectively project pixels of an image to healthy cells atthe periphery of the periphery of the retina.

40. The device of Embodiment 38, wherein the wearable device isconfigured to selectively project a portion of the image to healthycells.

41. A wearable virtual reality device configured to be used by a wearer,said display device comprising:

-   -   a head-mounted display comprising a virtual reality display        platform; and    -   a light source configured to project light into the eye of the        wearer to form an image in the eye;    -   wherein the wearable device is configured to alter the light        projected to damaged areas of the eye.

42. The device of embodiment 41, wherein the wearable device isconfigured to magnify pixels of the image projected to damaged areas ofthe eye.

43. The device of embodiment 41, wherein the wearable device isconfigured to increase or decrease the intensity of the pixels of theimage projected to damaged areas of the eye.

44. The device of embodiment 41, wherein the wearable device isconfigured to increase or decrease the contrast of the pixels of theimage projected to damaged areas of the eye.

45. The device of embodiment 41, wherein the wearable device isconfigured to alter the hue of the pixels of the image projected todamaged areas of the eye.

46. The device of embodiment 41, wherein the wearable device isconfigured to alter the light projected for specific wavelengthsdetermined to have reduced sensitivity when projected on said damagedareas of the eye.

47. The device of embodiment 46, wherein the wearable device isconfigured to magnify pixels of the image projected to damaged areas ofthe eye.

48. The device of embodiment 46, wherein the wearable device isconfigured to increase the intensity of the pixels of the imageprojected to damaged areas of the eye.

49. The device of embodiment 46, wherein the wearable device isconfigured to increase the contrast of the pixels of the image projectedto damaged areas of the eye.

50. A wearable display device configured to be used by a wearer, saiddisplay device comprising:

-   -   a head-mounted ophthalmic system;    -   a light source configured to direct light into an eye of said        wearer to form an image in the eye; and    -   an adaptable optics element configured to receive light from the        light source,    -   wherein the wearable device is configured to selectively project        pixels of an image to healthy cells.

51. The device of embodiment 50, wherein the adaptable optics elementcomprises a variable focus element.

52. The device of embodiment 50, wherein the variable focus elementcomprises a membrane mirror.

53. The device of embodiment 52, further comprising:

-   -   one or more electrodes coupled to the membrane mirror; and    -   a control system configured to selectively control the one or        more electrodes to modify a shape of the membrane mirror.

54. The device of any of Embodiments 1-28, wherein the wearable deviceis configured to selectively project pixels of an image to healthycells.

55. The device of Embodiment 53, wherein the wearable device isconfigured to selectively project pixels of an image to healthy cells atthe periphery of the retina.

56. The device of Embodiment 53, wherein the light source is configuredto selectively project a portion of the image to healthy cells.

57. The device of any of Embodiment 1-23, wherein the wearable device isconfigured to alter the light projected to the eye.

58. The device of Embodiment 56, wherein the wearable device isconfigured to magnify pixels of the image projected to damaged areas ofthe eye.

59. The device of embodiment 56, wherein the wearable device isconfigured to increase the contrast of the pixels of the image projectedto damaged areas of the eye.

60. The device of embodiment 56, wherein the wearable device isconfigured to alter the light projected for specific wavelengthsdetermined to have reduced sensitivity when projected on said damagedareas of the eye.

61. The device of embodiment 59, wherein the wearable device isconfigured to magnify pixels of the image projected to damaged areas ofthe eye.

62. The device of embodiment 59, wherein the wearable device isconfigured to increase the intensity of the pixels of the imageprojected to damaged areas of the eye.

63. The device of embodiment 59, wherein the wearable device isconfigured to increase the contrast of the pixels of the image projectedto damaged areas of the eye.

64. The device of embodiment 28, wherein the multiple depth planes areseparated by at least 10 centimeters.

65. The device of any of embodiments 28 or 63, wherein the multipledepth planes comprises at least 3 depth planes.

66. The device of embodiment 37, wherein the wearable device isconfigured to increase or decrease the spatial frequency of a periodicimage projected to damaged areas of the eye.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Contrast Testing

1. A wearable augmented reality device configured to be used by awearer, said display device comprising:

an augmented reality head-mounted ophthalmic system comprising anaugmented reality display platform, said augmented reality head-mountedophthalmic system configured to pass light from the world into an eye ofa wearer wearing the head-mounted system;

a light source configured to project light into the eye of the wearer toform an image in the eye; and

a user interface configured to receive input from a user,

wherein the wearable augmented reality device is configured to projectthe image to the wearer and to detect a response regarding the image todetermine a contrast sensitivity of the wearer.

2. A wearable virtual reality device configured to be used by a wearer,said display device comprising:

a head-mounted display comprising a virtual reality display platform;and

a light source configured to project light into the eye of the wearer toform an image in the eye, and

a user interface configured to receive input from a user,

-   -   wherein the wearable virtual reality device is configured to        project the image to the wearer and to detect a response        regarding the image to determine a contrast sensitivity of the        wearer.

3. The device of embodiment 1 or 2, wherein said image comprises aplurality of regions having different contrast levels.

4. The device of embodiment 3, wherein said image comprises a sine-wavegrating.

5. The device of embodiment 3, wherein said image comprises a pluralityof letters or numbers projected at different contrast levels.

6. The device of embodiment 5, wherein said image comprises aPelli-Robson chart.

7. The device of embodiment 5, wherein the wearable device is configuredto detect a response from the wearer indicating the letters, numbers, orshapes that are visible to the wearer.

8. The device of embodiment 1 or 2, wherein the light source isconfigured to consecutively project a plurality of images to the wearer.

9. The device of embodiment 8, wherein each of the plurality of imagesdiffers from at least one other of the plurality of images in contrast.

10. The device of embodiment 9, wherein the wearable device isconfigured to detect a response from the wearer indicating the wearer'sability to detect a contrast feature within the image.

11. The device of embodiment 1 or 2, wherein the light source isconfigured to decrease the contrast of said image over time.

12. The device of embodiment 11, wherein the wearable device isconfigured to detect a response from the wearer indicating a time atwhich the wearer cannot discern contrasting features of the image.

13. The device of any of embodiments 1-12, further comprising a displayfor forming the image in the eye of the wearer.

14. The device of embodiment 13, wherein the display comprises a fiberscanning display.

15. The device of embodiment 13 or 14, wherein the display furthercomprises a waveguide stack.

16. The device of any of embodiments 10-12, wherein the display isconfigured to produce images at multiple depth planes.

17. The device of any of embodiments 1-16, wherein the wearable deviceis configured to perform a plurality of contrast sensitivitymeasurements and perform a comparative analysis of the results.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Visual Fields

1. A wearable augmented reality device configured to be used by awearer, said display device comprising:

an augmented reality head-mounted ophthalmic system comprising anaugmented reality display platform, said augmented reality head-mountedophthalmic system configured to pass light from the world into an eye ofa wearer wearing the head-mounted system;

a light source configured to project light into the eye of the wearer toform a moving image in the eye; and

a user interface configured to receive input from a user.

wherein the wearable augmented reality device is configured to projectthe image at a particular portion of the periphery of the wearer'svisual field and to detect a response regarding the image to determinethe health of that portion of the visual field.

2. A wearable virtual reality device configured to be used by a wearer,said display device comprising:

a head-mounted display comprising a virtual reality display platform;and

a light source configured to project light into the eye of the wearer toform a moving image in the eye, and

a user interface configured to receive input from a user,

-   -   wherein the wearable virtual reality device is configured to        project the image at a particular portion of the periphery of        the wearer's visual and to detect a response regarding the image        to determine the health of that portion of the visual field.

3. The device of embodiment 1 or 2, wherein said moving image movesinward from the periphery of the wearer's visual field toward the centerof the wearer's visual field.

4. The device of embodiment 3, wherein the wearable device is configuredto detect a response from the wearer indicating the time at which theimage becomes visible to the wearer.

5. The device of embodiment 3, wherein the wearable device is configuredto detect a response from the wearer regarding an observedcharacteristic of the image.

6. The device of embodiment 3, wherein the light source is furtherconfigured to project an image of an object approaching the eye of thewearer.

7. The device of any of embodiments 1-6, further comprising a displayfor forming the image in the eye of the wearer.

8. The device of embodiment 7, wherein the display comprises a fiberscanning display.

9. The device of embodiment 7 or 8, wherein the display furthercomprises a waveguide stack.

10. The device of any of embodiments 7-9, wherein the display isconfigured to produce images at multiple depth planes.

11. The device of any of embodiments 1-10, wherein the device isconfigured to provide a visual, audio, or tactile notification to thewearer based on detecting a hazard in an unhealthy portion of thewearer's visual field.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Laser Therapy

1. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted        ophthalmic system; and    -   a laser configured to administer laser therapy to the eye of the        wearer.

2. The device of embodiment 1, wherein the device is configured todirect laser light to the eye at an intensity, wavelength, and durationto alter eye tissue.

3. The device of embodiment 1, wherein the laser is configured to reducea growth of abnormal blood vessels or to close abnormal blood vessels.

4. The device of embodiment 3, wherein the laser is configured toperform full laser photocoagulation.

5. The device of embodiment 3, wherein the laser is configured to treatwet age-related macular degeneration.

6. The device of embodiment 1, further comprising a module configured toinject a photosensitizer into the eye, the laser configured to activatethe photosensitizer.

7. The device of embodiment 1, wherein the wearable augmented realitydevice is configured to determine an area for exposure to light from thelaser.

8. The device of embodiment 7, wherein the wearable augmented realitydevice is configured to determine the area for exposure by imaging aretina and surrounding tissue of the eye and determining a presence ofchoroidal neurovascularization.

9. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to provide instructions tothe wearer before exposing the wearer to light from the laser.

10. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to display images to thewearer as part of the laser therapy.

11. The device of embodiment 10, wherein the augmented realityhead-mounted ophthalmic system is configured to display the instructionsto the wearer before exposing the wearer to light from the laser.

12. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to orient the eye of thewearer in a desired direction during exposing the wearer to light fromthe laser, wherein the augmented reality head-mounted ophthalmic systemis configured to orient the eye by displaying an object for the eye ofthe wearer to focus on.

13. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to display a moving objectas part of the laser therapy.

14. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to provide instructions tothe wearer after exposing the wearer to light from the laser.

15. The device of embodiment 14, wherein the instructions comprise oneor more of shutting the eyelids for a set duration and blinking a setnumber of times.

16. The device of embodiment 1, wherein the laser is mounted to a frameof the ophthalmic system.

17. The device of embodiment 1, further comprising an adaptable opticselement configured to project an image to a particular portion of thewearer's eye.

18. The device of embodiment 17, wherein the adaptable optics elementcomprises a variable focus element.

19. The device of embodiment 18, wherein the variable focus elementcomprises a membrane mirror.

20. The device of embodiment 19, further comprising:

one or more electrodes coupled to the membrane mirror; anda control system configured to selectively control the one or moreelectrodes to modify a shape of the membrane mirror.

21. The device of embodiment 1, further comprising a fiber scanningprojector for outputting light to form images in the eye of the wearer.

22. The device of embodiment 1, further comprising a waveguide stackcomprising a plurality of waveguides, wherein different waveguides areconfigured to project light at different focal planes.

23. The device of embodiment 22, wherein the waveguide stack furthercomprises one or more lenses.

24. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer; and a laser        configured to selectively administer laser therapy to the eye of        the wearer.

25. The device of embodiment 24, wherein the virtual realityhead-mounted ophthalmic system is configured to not pass light from theworld in front of the head-mounted ophthalmic system into the eye of thewearer wearing the head-mounted ophthalmic system that would form animage of the world in the eye of the wearer.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Delivery of Medication

1. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted        ophthalmic system.    -   wherein the augmented reality head-mounted ophthalmic system is        configured to deliver medication to the eye of the wearer.

2. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver the medicationto the eye of the wearer based on a treatment protocol.

3. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer while the medication is delivered.

4. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer to keep the eye open while the medication is delivered.

5. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer to focus on a visual cue while the medication is delivered.

6. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver the medicationas part of a light or laser therapy.

7. The device of embodiment 6, wherein the medication is photosensitiveto wavelengths of light used for the light or laser therapy.

8. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted        ophthalmic system,    -   wherein the augmented reality head-mounted ophthalmic system is        configured to deliver a liquid to the eye of the wearer.

9. The device of embodiment 8, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver a spray or mistof the liquid to the eye.

10. The device of embodiment 8, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver drops of theliquid to the eye.

11. The device of embodiment 8, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver a stream of theliquid to the eye.

12. The device of embodiment 8, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver a salinesolution to the eye of the wearer.

13. The device of embodiment 12, wherein the augmented realityhead-mounted ophthalmic system is configured to detect that the eye isdry and to deliver the saline solution when the eye is dry.

14. The device of embodiment 12, wherein the augmented realityhead-mounted ophthalmic system is configured to detect that red orbloodshot eyes, and to deliver the saline solution upon detection of thered or bloodshot eyes.

15. The device of embodiment 8, wherein the augmented realityhead-mounted ophthalmic system further comprises one or more sensors tomeasure one or more of a temperature of the wearer, a duration since animmediately previous delivery of liquid or powdered medication to theeye, an ambient humidity, a presence of foreign objects on the eye, apresence of chemical irritants in the eyes, and/or a pollen orparticulate count.

16. The device of embodiment 15, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver the liquid tothe eye based upon one or more measurements of the one or more sensorsexceeding a threshold.

17. The device of embodiment 15, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver sufficientliquid to flush the eye.

18. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer,    -   wherein the virtual reality head-mounted ophthalmic system is        configured to deliver medication to the eye of the wearer.

19. The device of embodiment 18, wherein the virtual realityhead-mounted ophthalmic system is configured to not pass light from theworld in front of the head-mounted ophthalmic system into the eye of thewearer wearing the head-mounted ophthalmic system that would form animage of the world in the eye of the wearer.

20. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer,    -   wherein the virtual reality head-mounted ophthalmic system is        configured to deliver saline to the eye of the wearer.

21. The device of embodiment 20, wherein the virtual realityhead-mounted ophthalmic system is configured to not pass light from theworld in front of the head-mounted ophthalmic system into the eye of thewearer wearing the head-mounted ophthalmic system that would form animage of the world in the eye of the wearer.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Platform for Other Treatments

1. A wearable augmented reality device configured to be used by awearer, the device comprising:

-   -   an augmented reality head-mounted ophthalmic system comprising        an augmented reality display platform, the augmented reality        head-mounted ophthalmic system configured to pass light from the        world into an eye of a wearer wearing the head-mounted system,    -   wherein the augmented reality head-mounted ophthalmic system is        configured to deliver therapy other than light therapy to the        wearer.

2. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver vibrationtherapy.

3. The device of embodiment 2, wherein the augmented realityhead-mounted ophthalmic system is configured to massage the face orskull of the wearer.

4. The device of embodiment 3, wherein the augmented realityhead-mounted ophthalmic system further comprises an actuator having acontact surface configured to contact the wearer during the massage.

5. The device of embodiment 5, wherein the actuator selected from thegroup consisting of piezoelectric actuators, eccentric cams, EccentricRotating Mass (ERM) vibration motors, and Linear Resonant Actuators(LNAs).

6. The device of embodiment 2, wherein the augmented realityhead-mounted ophthalmic system further comprises speakers configured todeliver sound therapy.

7. The device of embodiment 6, wherein the augmented realityhead-mounted ophthalmic system is configured to output binaural beats.

8. The device of embodiment 6, wherein the augmented realityhead-mounted ophthalmic system is configured to direct sound waves tothe eye.

9. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver temperaturetherapy to the wearer.

10. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system further comprises a cooler.

11. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver cool air cooledby the cooler to the wearer.

12. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system further comprises a heater.

13. The device of embodiment 9, wherein the augmented realityhead-mounted ophthalmic system is configured to deliver heated airheated by the heater to the eye.

14. The device of embodiment 1, further comprising an EEG sensor,wherein the augmented reality head-mounted ophthalmic system isconfigured to deliver the therapy based upon a physiological state ofthe wearer measured by the EEG sensor.

15. The device of embodiment 1, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer while the therapy is delivered.

16. The device of embodiment 15, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer to keep the eye open while the therapy is delivered.

17. The device of embodiment 15, wherein the augmented realityhead-mounted ophthalmic system is configured to provide an alert to thewearer to focus on a visual cue while the therapy is delivered.

18. The device of embodiment 15, wherein the augmented realityhead-mounted ophthalmic system is configured to direct air to the eyeduring the therapy.

19. A wearable virtual reality device configured to be used by a wearer,the device comprising:

-   -   a virtual reality head-mounted ophthalmic system comprising a        virtual reality display platform comprising a display for        providing images to the eye of the wearer,    -   wherein the virtual reality head-mounted ophthalmic system is        configured to deliver therapy other than light therapy to the        eye of the wearer.

20. The device of embodiment 19, wherein the virtual realityhead-mounted ophthalmic system is configured to not pass light from theworld in front of the head-mounted system into the eye of the wearerwearing the head-mounted system that would form an image of the world inthe eye of the wearer.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Outward Looking Camera

1. A wearable display system, the display system comprising:

-   -   a head-mounted display; and    -   at least one outward looking camera configured to capture an        image of the world around a wearer of the head-mounted display,    -   wherein the display system is configured to process the image of        the world, re-render the image of the world, and project the        re-rendered image from the head-mounted display to an eye of the        wearer.

2. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world is at least inpart based on a known ophthalmic condition of the wearer.

3. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by modifying ahue of at least a portion of the image.

4. The wearable display system of embodiment 3, wherein the displaysystem is configured to re-render the image of the world by shifting acolor of at least a portion of the image.

5. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by modifying anintensity of at least a portion of the image.

6. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by alteringportions of the image based on a distribution of health and unhealthycells in a retina of the wearer.

7. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by modifying awavefront of at least a portion of the image.

8. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by magnifyingat least a portion of the image.

9. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by modifyingthe saturation of at least a portion of the image.

10. The wearable display system of embodiment 1, wherein the displaysystem is configured to re-render the image of the world by modifying aspatial frequency of at least a portion of the image.

11. The wearable display system of embodiment 1, wherein thehead-mounted display comprises a virtual reality display.

12. The wearable display system of embodiment 1, wherein thehead-mounted display comprises an augmented reality display deviceconfigured to pass light from the world into an eye of the wearer.

13. The wearable display system of any of embodiments 1-12, wherein thehead-mounted display comprises a light field display.

The additional numbered embodiments below in the section titled“ADDITIONAL NUMBERED EMBODIMENTS” are to be repeated, added to, andconcatenated to the list of numbered embodiments here as if the list ofadditional numbered embodiments below in the section titled “ADDITIONALNUMBERED EMBODIMENTS” immediately followed the list of numberedembodiments here.

Additional Numbered Embodiments

These additional embodiments are to be added to the list of embodimentsprovided in the different sections above including without limitationthe sections titled: Myopia/Hyperopia/Astigmatism; Presbyopia;Strabismus/Amblyopia; Higher Order Aberrations; Chromatic Aberration;Phoropter; Red Reflex; Intraocular Pressure; Pinhole Occluder; InitialW4LT Test; Retinoscopy; Slit Lamp; Color Blindness:Ophthalmoscope/Funduscope; Confocal Microscopy/Two-PhotonMicroscopy/SLO; Two-Photon Microscopy; Autorefractor; OCT; Aberrometer;Ultrasound; Electrooculography (EOG), Electroencenphalography (EEG), andElectroretinography (ERG): Light Therapy; Macular Degeneration; ContrastTesting; Visual Fields; Laser Therapy; Delivery of Medication; Platformfor Other Treatments; and Outward Looking Camera.

These additional embodiments are to be repeated and concatenated to thelist of embodiments provided in each of the different sections above asif the list below immediately followed the list of embodiments in aparticular section. In addition, the additional numbered embodimentsbelow will be understood to apply to any of the claims of thisapplication, and, in determining the subject matter encompassed by theseembodiments, the references to the “device of any of the aboveembodiments” will be understood to also be a reference to any of theclaims below.

1. The device of any of the above embodiments, wherein the devicecomprises a light field display.

2. The device of any of the above embodiments, wherein the device isconfigured to project images to the eye of the wearer from differentdepth planes.

3. The device of any of the above embodiments, wherein the devicecomprises a plurality of optical elements having optical power toproject images from different depth planes.

4. The device of any of the above embodiments, wherein the devicecomprises a plurality of lenses having optical power to project imagesfrom different depth planes.

5. The device of any of the above embodiments, wherein the device isconfigured to project images from different depth planes into an eyeusing time multiplexing such that images for different depth planes areprojected at different times.

6. The device of any of the above embodiments, wherein the device isconfigured to project at least one beam of light in a scanning patternin the eye of the wearer.

7. The device of any of the above embodiments, wherein the device isconfigured to project at least one beam of light in a scanning patternin the eye of the wearer to form an image.

8. The device of any of the above embodiments, wherein the displaydevice is configured to project at least one beam of light having alateral dimension of between 1 and 25 microns in the eye of the wearer.

9. The device of any of the above embodiments, further comprising atransmissive adaptive optics element.

10. The device of any of the above embodiments, further comprising atransmissive adaptive optics element, wherein the transmissive adaptiveoptics element comprises an adaptive optics lens or a spatial lightmodulator that modulates phase.

11. The device of any of the above embodiments, further comprising atransmissive adaptive optics element comprising a deformable lens.

12. The device of any of the above embodiments, further comprising atransmissive adaptive optics element comprising a deformable lens thatcomprises a deformable elastomeric lens.

13. The device of any of the above embodiments, wherein the device isconfigured to track data on the user obtained by the device over aperiod of time.

14. The device of any of the above embodiments, wherein the device isfurther configured to account for results in previous tests,examinations, or procedures performed by the device when providingoutput or controlling light reaching the user.

15. The device of any of the above embodiments, wherein the device isfurther configured to modify providing output or controlling lightreaching the user based at least in part on results of one or moreprevious test, examinations or procedures performed by the device.

16. The device of any of the above embodiments, wherein the test,examination, or procedure performed by the device is initialized basedat least in part on results from previous tests, examinations, orprocedures performed by the device.

17. The device of any of the above embodiments, wherein the devicecomprises a gaming system.

18. The device of any of the above embodiments, wherein the devicecomprises an entertainment system.

19. The device of any of the above embodiments, wherein the devicecomprises a personal display system.

20. The device of any of the above embodiments, wherein the devicecomprises an occupational display system.

21. The device of any of the above embodiments, wherein the device isconfigured to perform tests, examinations or procedures while presentinga movie.

22. The device of any of the above embodiments, wherein the device isconfigured to perform tests, examinations, or procedures while thewearer is playing a video game.

23. The device of any of the above embodiments, wherein the device isconfigured to acquire test results based at least in part onmeasurements of the eye of the wearer while presenting a movie.

24. The device of any of the above embodiments, wherein the device isconfigured to acquire test results based at least in part onmeasurements of the eye of the wearer while playing a video game.

25. The device of any of the above embodiments, wherein the device isconfigured to project a movie wherein portions of the movie areprojected from a variety of depth planes and to perform tests,examinations, or procedures on the eye of the wearer based onmeasurements of the eye when viewing the portions of the movie projectedfrom the variety of depth planes.

26. The device of any of the above embodiments, wherein the device isconfigured to present a video game wherein portions of the video gameare presented from a variety of depth planes and to perform tests,examinations, or procedures on the eye of the wearer based onmeasurements of the eye when playing the video game presented from thevariety of depth planes.

27. The device of any of the above embodiments, wherein the device is amedical system configured for use by an optometrist, clinician, ordoctor.

28. The device of any of the above embodiments, wherein the test,examination, or procedure is administered from an office of theoptometrist, clinician, or doctor or from a hospital, clinic, or medicalfacility.

29. The device of any of the above embodiments, wherein the device isprimarily configured as an ophthalmic system configured to performophthalmic diagnostics or perform ophthalmic treatments.

30. The device of any of the above embodiments, wherein the device isprimarily configured as an ophthalmic system configured to determinerefractive errors or administer eye exams.

31. The device of any of the above embodiments, wherein the tests,examinations, or procedures are performed by the device multiple timesper year.

32. The device of any of the above embodiments, wherein the tests,examinations, procedures are performed by the device multiple times perweek.

33. The device of any of the above embodiments, wherein the tests,examinations, procedures are performed by the device multiple times perday.

34. The device of any of the above embodiments, wherein the tests,examinations, or procedures are performed by the device at a wearer'sdiscretion.

35. The device of any of the above embodiments, wherein the tests,examinations, or procedures are dynamically scheduled or suggested basedat least in part on results obtained by the device of monitoringperformance of the eye of the wearer.

36. The device of any of the above embodiments, wherein a scheduled timefor a test, examination, or procedure is modified based at least in parton results of the device monitoring performance of the eye of thewearer.

37. The device of any of the above embodiments, wherein device isconfigured to generate an alert that the device will be performing atest, examination or procedure on the wearer.

38. The device of any of the above embodiments, wherein device isconfigured to generate an alert that the device has completed a test,examination or procedure on the wearer.

39. The device of any of the above embodiments, wherein the device isconfigured to generate an alert to the wearer when performance of theeye of the wearer is outside a targeted performance range.

40. The device of any of the above embodiments, wherein device isconfigured to generate an alert comprising a suggested test based onperformance characteristics of the eye that are outside the targetedperformance range.

41. The device of any of the above embodiments, wherein device isconfigured to generate an alert comprising information on performancecharacteristics of the eye that are outside the targeted performancerange.

42. The device of any of the above embodiments, wherein device isconfigured to generate an alert comprising a sound or visualnotification presented to the wearer to indicate a suggested test.

43. The device of any of the above embodiments, wherein device isconfigured to generate an alert comprising a sound or visualnotification presented to the wearer to indicate which performancecharacteristics are outside the targeted performance range.

44. The device of any of the above embodiments, wherein the device isconfigured to:

-   -   obtain information regarding an ambient environment of the        eyewear;    -   measure biological characteristics of the wearer; and    -   determine a relationship between the information and the        measured biological characteristics.

45. The device of the embodiment 44, wherein the device is configured toobtain the information regarding the ambient environment by using anoutward facing camera to acquire images of objects in the environmentoutside of the eyewear; and wherein the device is configured todetermine a relationship between the objects in the acquired images andthe measured biological characteristics.

46. The device of embodiment 45, wherein the objects in the acquiredimages comprise food.

47. The device of any of embodiments 44-46, wherein the biologicalcharacteristics comprise at least one of a heart rate or a trend inblood pressure.

48. The device of any of embodiments 44-47, wherein the relationship isstored to accrue historical records of the determined relationships.

49. The device of any of embodiments 44-48, wherein the device isconfigured to obtain the information regarding the ambient environmentby determining a location of the wearer, wherein the informationcharacterizes one or more conditions of the ambient environment at thelocation.

50. The device of the any of embodiments 44-49, wherein the device isconfigured to obtain the information regarding the ambient environmentby accessing a remote data repository.

51. The device of any of embodiments 44-50, wherein the informationdescribes one or more of pollen count, pollution, demographics,environmental toxins, interior climate and air quality conditions,lifestyle statistics, and proximity to health-care providers.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate some examples of embodiments disclosed hereinand do not limit the invention. It should be noted that the figures arenot drawn to scale and that elements of similar structures or functionsare represented by like reference numerals throughout the figures.

FIG. 1 illustrates a traditional ophthalmic instrument being used at aclinician's office.

FIG. 2 illustrates a cross-section of a human eye.

FIG. 3A-3D illustrates various configurations of an example ophthalmicdevice.

FIG. 4A-4D illustrates various eye and head measurements taken in orderto configure the ophthalmic device for a particular user.

FIG. 5 shows a schematic view of various components of an ophthalmicdevice according to some embodiments.

FIG. 6 is an example process flow for varying the focus of the healthsystem according to some embodiments.

FIG. 7A-7B illustrates a schematic, cross-sectional view of a user's eyesuffering from myopia.

FIG. 8A-8B illustrates a schematic, cross-sectional view of a user's eyesuffering from hyperopia.

FIG. 9A-9B illustrates a schematic, cross-sectional view of a user's eyesuffering from astigmatism.

FIG. 10A illustrates an example process flow for correcting for visiondefects according to some embodiments.

FIG. 10B-10E illustrates examples of structures for correcting opticalprescriptions according to some embodiments.

FIG. 11 illustrates an example process flow for correcting presbyopiaaccording to some embodiments.

FIG. 12 illustrates an example method for treating convergencedeficiencies, such as those caused by strabismus and/or amblyopia, byoccluding an eye of the wearer.

FIG. 13 illustrates an example process flow for detecting dead spots inthe macula, according to some embodiments.

FIG. 14 illustrates an example of a wearable augmented reality deviceconfigured to function as a phoropter or refractor.

FIG. 15 illustrates an example method for determining an opticalprescription of a wearer of an augmented or virtual reality deviceconfigured for use as a virtual phoropter.

FIG. 16A schematically illustrates an example configuration of a systemfor determining an intraocular pressure of an eye.

FIG. 16B illustrates an example process flow for determining intraocularpressure according to some embodiments.

FIG. 17A-C illustrates embodiments of example pinhole occluder devicesaccording to some embodiments.

FIG. 17D illustrates an example process flow for administering a pinholeoccluding test according to some embodiments.

FIG. 17E illustrates an example pinhole occluder comprising multiplepinholes according to some embodiments.

FIG. 17F illustrates an example process flow of correcting visiondefects utilizing pinhole occluders according to some embodiments.

FIG. 18 illustrates an example method of administering a Worth FourLight Test or Worth Four Dot Test to assess the wearer's degree ofbinocular single vision.

FIG. 19 illustrates an example method for measuring refractive error ofa wearer of an augmented reality device configured to performretinoscopy.

FIG. 20A illustrates a patient worn ophthalmic device configured as aslit lamp diagnostic tool.

FIG. 20B illustrates an example process flow for administering a slitlamp test.

FIG. 21A illustrates a schematic view of various color plates.

FIG. 21B schematically illustrates an example system for generating adark background in an augmented reality system.

FIG. 22A schematically illustrates an augmented reality/virtual realityeyewear configured as an ophthalmoscope/funduscope.

FIG. 22B illustrates an example process flow of using the health systemas a funduscope, according to some embodiments.

FIG. 22C is a schematic partial illustration of an embodiment configuredto provide illumination to structures at various depths in the eye aswell as image the structures at different depths in the eye.

FIG. 23A schematically illustrates a set-up to perform optical coherencetomography (OCT) examination.

FIG. 23A-1 is a partial schematic illustration of an example of anaugmented reality/virtual reality eyewear comprising a fiber scanningdevice and a plurality of waveguides that are configured to performoptical coherence tomography (OCT) examination.

FIG. 23B schematically illustrates an augmented reality/virtual realityeyewear comprising a plurality of photodetectors configured to receivelight reflected/back-scattered from the eye.

FIG. 23C illustrates an example process flow and system configurationsof using the health system as an OCT system, according to someembodiments.

FIG. 24A is a schematic illustration of an augmented reality/virtualreality eyewear comprising one or more ultrasonic probe and one or moreultrasound transmitters and receivers.

FIG. 24B illustrates an example process flow for using ultrasoundthrough the ophthalmic device, according to some embodiments.

FIG. 24C schematically illustrates an augmented reality/virtual realityeyewear configured to perform confocal microscopy, scanning laserophthalmoscopy or two-photon microscopy.

FIG. 24D-1 is a partial schematic illustration of an embodiment of anaugmented reality/virtual reality eyewear comprising a fiber scanningdevice and a plurality of waveguides that are configured to performconfocal microscopy, scanning laser ophthalmoscopy or two-photonmicroscopy.

FIG. 24D-2 is a schematic partial illustration of an embodiment of aneyewear comprising an optical source, one or more imaging devices, abeam splitter, a lensing system and a scanning mirror.

FIG. 24E illustrates an example process flow and system configurationsof using the augmented reality/virtual reality eyewear as a confocalmicroscope.

FIG. 24F is a schematic illustration of an augmented reality/virtualreality eyewear comprising electrodes positioned around a user's eye.

FIG. 25 illustrates a schematic view of an exemplary configuration of anhealth system.

FIG. 26A-G illustrates example embodiments of an augmented and/orvirtual reality system configured as an autorefractor.

FIG. 27 illustrates an example embodiment of an augmented and/or virtualreality system configured as a wavefront aberrometer.

FIG. 28A schematically illustrates an example of a scanning fiber.

FIG. 28B schematically illustrates an example of a display using ascanning fiber.

FIG. 28C schematically illustrates an example spiral pattern formed by amoving scanning fiber of a fiber scanning display.

FIG. 29A schematically illustrates an example embodiment of a systemwith transmissive adaptive optics.

FIG. 29B schematically illustrates an example embodiment of a systemwith reflective adaptive optics.

DETAILED DESCRIPTION

Various embodiments of the invention are directed to methods, systems,and articles of manufacture for implementing a user-wearable healthsystem, which may be used for performing health-related diagnostics,monitoring, and therapeutics on the user. Various objects, features, andadvantages of the invention are described in the detailed description,figures, and claims.

Various embodiments will be described in detail with reference to thedrawings, which are provided as illustrative examples of the inventionso as to enable those skilled in the art to practice the invention.Notably, the figures and the examples below are not meant to limit thescope of the present invention. Where certain elements of the presentinvention may be partially or fully implemented using known components(or methods or processes), only those portions of such known components(or methods or processes) that are necessary for an understanding of thepresent invention will be described, and the detailed descriptions ofother portions of such known components (or methods or processes) willbe omitted so as not to obscure the invention. Further, variousembodiments encompass present and future known equivalents to thecomponents referred to herein by way of illustration.

Disclosed are methods and systems for diagnosing and/or treating healthailments of patients through a user-wearable health system, e.g., auser-wearable ophthalmic device that interacts with the user's eyes. Inone or more embodiments, the device may be a head-mounted system capableof performing one or more diagnostic or treatment regimens. In someother embodiments, the device may be stationary (e.g., stationary at aphysician's office). In one or more embodiments, the device may be anaugmented reality system that advantageously combines many augmentedreality (AR) and/or virtual reality (VR) techniques for health orophthalmic purposes. In some other embodiments, the clinician may wearthe device for the purpose of diagnosis and/or simulation and training.Various embodiments described below discuss a new paradigm of healthsystems in relation to AR systems, but it should be appreciated that thetechniques disclosed here may be used independently of any existingand/or known AR systems. Thus, the examples discussed below are forexample purposes only and should not be read to be limited to ARsystems.

As noted above, embodiments of the present inventions present a newparadigm in which user-wearable diagnostic health or health therapysystems (generally referred to herein as health systems), e.g.,ophthalmic instruments, are worn by the patient, and may be programmedwith one or more applications specific to various health-related, e.g.,eye-related, ailments. In some embodiments, diagnoses and/or treatmentmay be provided by optical, mechanical structures, processing algorithmsor any combination of the above. In some other embodiments, the patientworn health system may further entail sensing and/or stimulatingcapabilities, for enhanced treatment or diagnostic purposes. In someembodiments, a head-worn augmented reality system may be used to providevarious health-related, e.g., ophthalmic, measurements, assessments,diagnoses or treatments.

Given that the head-mounted augmented reality display system interactswith the user's eyes, many applications may be envisioned foreye-related diagnostics and therapeutics. Further, many otherapplications in non-eye diagnostics and therapeutics may be similarlyenvisioned. Accordingly, the disclosure presented herein is not limiteddiagnosing, monitoring, and treating the eye. Embodiments disclosedherein may also be applied to diagnose, monitor, and treat other areasof the user's health, including but not limited to the user'scardiovascular and neurological health.

Many embodiments of the health system will be discussed in relation tovarious eye-related and other ailments. Prior to delving into variousembodiments of the health system, the biological mechanisms of the humaneye will be briefly discussed below to provide context to commonailments that may affect patients.

Referring to FIG. 2, a simplified cross-sectional view of a human eye isdepicted featuring a cornea (42), iris (44), lens—or “crystalline lens”(46), sclera (48), choroid layer (50), macula (52), retina (54), andoptic nerve pathway (56) to the brain. The macula is the center of theretina, which is utilized to see moderate detail; at the center of themacula is a portion of the retina that is referred to as the “fovea”,which is utilized for seeing the finest details, and which contains morephotoreceptors (approximately 120 cones per visual degree) than anyother portion of the retina. The human visual system is not a passivesensor type of system; it is configured to actively scan theenvironment. In a manner somewhat akin to use of a flatbed scanner tocapture an image, or use of a finger to read Braille from a paper, thephotoreceptors of the eye fire in response to changes in stimulation,rather than constantly responding to a constant state of stimulation.

Thus, motion is required to present photoreceptor information to thebrain (as is motion of the linear scanner array across a piece of paperin a flatbed scanner, or motion of a finger across a word of Brailleimprinted into a paper). Indeed, experiments with substances such ascobra venom, which has been utilized to paralyze the muscles of the eye,have shown that a human subject will experience blindness if positionedwith his eyes open, viewing a static scene with venom-induced paralysisof the eyes. In other words, without changes in stimulation, thephotoreceptors do not provide input to the brain and blindness isexperienced. It is believed that this is at least one reason that theeyes of normal humans have been observed to move back and forth, ordither, in side-to-side motion in what are called “microsaccades”.

As noted above, the fovea of the retina contains the greatest density ofphotoreceptors, and while humans typically have the perception that theyhave high-resolution visualization capabilities throughout their fieldof view, they generally actually have only a small high-resolutioncenter that they are mechanically sweeping around a lot, along with apersistent memory of the high-resolution information recently capturedwith the fovea. In a somewhat similar manner, the focal distance controlmechanism of the eye (ciliary muscles operatively coupled to thecrystalline lens in a manner wherein ciliary relaxation causes tautciliary connective fibers to flatten out the lens for more distant focallengths; ciliary contraction causes loose ciliary connective fibers,which allow the lens to assume a more rounded geometry for more close-infocal lengths) dithers back and forth by approximately ¼ to ½ diopter tocyclically induce a small amount of what is called “dioptric blur” onboth the close side and far side of the targeted focal length; this isutilized by the accommodation control circuits of the brain as cyclicalnegative feedback that helps to constantly correct course and keep theretinal image of a fixated object approximately in focus.

The visualization center of the brain also gains valuable perceptioninformation from the motion of both eyes and components thereof relativeto each other. Vergence movements (i.e., rolling movements of the pupilstoward or away from each other to converge the lines of sight of theeyes to fixate upon an object) of the two eyes relative to each otherare closely associated with focusing (or “accommodation”) of the lensesof the eyes. Under normal conditions, changing the focus of the lensesof the eyes, or accommodating the eyes, to focus upon an object at adifferent distance will automatically cause a matching change invergence to the same distance, under a relationship known as the“accommodation-vergence reflex.” Likewise, a change in vergence willtrigger a matching change in accommodation, under normal conditions.Working against this reflex, as do most conventional stereoscopic AR orVR configurations, is known to produce eye fatigue, headaches, or otherforms of discomfort in users.

Movement of the head, which houses the eyes, also has a key impact uponvisualization of objects. Humans move their heads to visualize the worldaround them; they often are in a fairly constant state of repositioningand reorienting the head relative to an object of interest. Further,most people prefer to move their heads when their eye gaze needs to movemore than about 20 degrees off center to focus on a particular object(i.e., people do not typically like to look at things “from the cornerof the eye”). Humans also typically scan or move their heads in relationto sounds—to improve audio signal capture and utilize the geometry ofthe ears relative to the head. The human visual system gains powerfuldepth cues from what is called “head motion parallax”, which is relatedto the relative motion of objects at different distances as a functionof head motion and eye vergence distance (i.e., if a person moves hishead from side to side and maintains fixation on an object, itemsfarther out from that object will move in the same direction as thehead; items in front of that object will move opposite the head motion;these are very salient cues for where things are spatially in theenvironment relative to the person—perhaps as powerful as stereopsis).Head motion also is utilized to look around objects, of course.

Further, head and eye motion are coordinated with something called the“vestibulo-ocular reflex”, which stabilizes image information relativeto the retina during head rotations, thus keeping the object imageinformation approximately centered on the retina. In response to a headrotation, the eyes are reflexively and proportionately rotated in theopposite direction to maintain stable fixation on an object. As a resultof this compensatory relationship, many humans can read a book whileshaking their head back and forth (interestingly, if the book is pannedback and forth at the same speed with the head approximately stationary,the same generally is not true—the person is not likely to be able toread the moving book; the vestibulo-ocular reflex is one of head and eyemotion coordination, generally not developed for hand motion). Thisparadigm may be significant for patient-worn health systems, becausehead motions of the user may be associated relatively directly with eyemotions, and the system preferably will be ready to work with thisrelationship. Thus, when designing a patient-worn or stationarydisplay-based health system, characteristics and sometimes, limitations,of the human eye are preferably taken into account to provide meaningfulvirtual reality content that works with eye's natural mechanisms ratherthan stressing it. Furthermore, in the context of health-relatedapplications of augmented reality display systems, this can provide avariety of advantages, as disclosed herein. As discussed above, thedisplay of the health system may be implemented independently ofaugmented reality (AR) systems, but many embodiments below are describedin relation to AR systems for illustrative purposes only.

Referring now to FIGS. 3A-3D, some general componentry options areillustrated. It should be appreciated that although the embodiments ofFIGS. 3A-3D illustrate head-mounted displays, the same components may beincorporated in stationary health systems as well, in some embodiments.

As shown in FIG. 3A, a user (60) is depicted wearing a patient-wornophthalmic device that includes a frame (64) structure coupled to adisplay system (62) positioned in front of the eyes of the user. Theframe 64 may be coupled to a number of ophthalmic-specific measurementsubsystems depending on the application of the health system. Someembodiments may be built for one or more ophthalmic applications, andother embodiments may be general AR systems that are also capable ofophthalmic applications. In either case, the following paragraphdescribes possible components of the health system or an AR system usedfor ophthalmic instrumentation and/or treatment.

In one or more embodiments, the health system is patient, or user, worn.In some other embodiments, the health system may be worn by anotherperson, e.g., a physician or clinician, and may be used to perform a setof diagnostics tests and/or treatment protocols on a patient that is notthe wearer of the system. It should be appreciated that any of theapplications below may be used for health systems worn other persons aswell for conducting diagnostics tests and/or treatment protocols on apatient.

A speaker (66) may be coupled to the frame (64) in the depictedconfiguration and positioned adjacent the ear canal of the user (in oneembodiment, another speaker, not shown, is positioned adjacent the otherear canal of the user to provide for stereo/shapeable sound control). Amicrophone (55) may also be coupled to the frame, to detect sound fromthe user or the ambient environment. In some embodiments, anothermicrophone (not illustrated) may be provided, e.g., coupled the frame(64) on the right hand side of the user. In one or more embodiments, thehealth system may have a display (62) that is operatively coupled (68),such as by a wired lead or wireless connectivity, to a local processingand data module (70) which may be mounted in a variety ofconfigurations, such as fixedly attached to the frame (64), fixedlyattached to a helmet or hat (80) as shown in the embodiment of FIG. 3B,embedded in headphones, removably attached to the torso (82) of the user(60) in a backpack-style configuration as shown in the embodiment ofFIG. 3C, or removably attached to the hip (84) of the user (60) in abelt-coupling style configuration as shown in the embodiment of FIG. 3D.

The local processing and data module (70) may comprise a power-efficientprocessor or controller, as well as digital memory, such as flashmemory, both of which may be utilized to assist in the processing,caching, and storage of data a) captured from sensors which may beoperatively coupled to the frame (64), such as image capture devices(such as cameras), microphones, inertial measurement units,accelerometers, compasses, GPS units, radio devices, and/or gyros;and/or b) acquired and/or processed using the remote processing module(72) and/or remote data repository (74), possibly for passage to thedisplay (62) after such processing or retrieval. The local processingand data module (70) may be operatively coupled (76, 78), such as via awired or wireless communication links, to the remote processing module(72) and remote data repository (74) such that these remote modules (72,74) are operatively coupled to each other and available as resources tothe local processing and data module (70).

In some embodiments, the remote processing module (72) may comprise oneor more relatively powerful processors or controllers configured toanalyze and process data and/or image information. In some embodiments,the remote data repository (74) may comprise a relatively large-scaledigital data storage facility, which may be available through theinternet or other networking configuration in a “cloud” resourceconfiguration. In some embodiments, all data is stored and allcomputation is performed in the local processing and data module,allowing fully autonomous use from any remote modules.

Advantageously, health systems (or AR systems having ophthalmicapplications) similar to those described in FIGS. 3A-3D provide uniqueaccess to a user's eyes and head. Given that the health system interactswith the user's eye to allow the user to perceive 3D virtual content,and in many embodiments, tracks various biometrics related to the user'seyes (e.g., eye vergence, eye motion, retinal structures, anterior andposterior eye geometry, patterns of eye movements, etc.), the resultanttracked data may be advantageously used in health-related applications,as described in further detail herein. This unprecedented access to theuser's eyes the implementation of various health applications. Dependingon the type of health ailment, the health system may be configured toprovide imaging of, sensing of (including measurements), and/orstimulation to the user's eyes to diagnose and/or treat the ailment.

In one or more embodiments, the augmented reality display system may beused as a patient-worn, or user-worn, ophthalmic device. Ophthalmicinstrumentation is used by clinicians to view into and a patient's eye,to execute a medical procedure and/or to perform tests on the user'seyes. Traditionally, ophthalmic devices have been large and bulkystationary devices, and often require a patient to go to a doctor'soffice, wherein a clinician or the doctor performs eye-related tests onthe patient. Typically, the patient is confined to the ophthalmicinstrumentation device (e.g., chin on chin-resting component ofophthalmic device, head forward, etc.) until the clinician has completedthe series of tests. Thus, the current approach has a number oflimitations.

In addition to using a heavy and bulky device for the tests, thetraditional approach requires doctor supervision, and the patient mayneed to return to the clinician's office repeatedly for furthertests/progress evaluations and may need to be in uncomfortable orrestriction positions for extended periods of time. Further, given theshort duration of time during which the patient is exposed to theophthalmic device, there are limitations on the amount of data theclinician is able to collect in order to diagnose or treat the patient.In addition, the traditional approach does not take into account theuser's behavior and dynamic changes in the orientation of the user. Manytests performed under the traditional approach require that the user beconstrained in a particular, usually static position. However, if theuser is taking a visual fields test and has limited attention span, theymay move their head and eyes, thereby creating noise and possiblycausing inaccurate test results.

In one or more embodiments, a head-worn health (e.g., ophthalmic) devicesimilar to the ones shown in FIG. 3A-3D may be used by a patient totrack data, identify and correct one or more eye-related ailments,and/or help prevent other health issues. In one or more embodiments, anAR display system may be used as a head-worn health (e.g., ophthalmic)device. It should be appreciated that a number of the embodimentsdescribed below may be implemented in head-worn embodiments, while otherembodiments may be implemented in stationary devices. Further, someembodiments may utilize AR technology to implement systems and methodsfor diagnosis, monitoring, and/or treatments with doctor supervision(e.g., for medical safety concerns, regulatory concerns, etc.), whileother embodiments may be implemented for self-diagnosis and/ormonitoring through the head-worn health devices or AR devices, or beimplemented as part of a treatment protocol for a particular ailment, asdescribed herein. For illustrative purposes, the disclosure will mainlyfocus on head-worn health devices, e.g., health systems, andparticularly AR devices, but it should be appreciated that the sameprinciples may be applied to non-head-worn embodiments as well.

In one or more embodiments, the AR display device may be used as apatient-worn health device, e.g., a patient-worn health system. Thedevice may be typically fitted for a particular user's head, and theoptical components are aligned to the user's eyes. These configurationsteps may be used in order to help ensure that the user is provided withan optimum augmented reality experience without causing anyphysiological side-effects, such as headaches, nausea, discomfort, etc.Thus, in one or more embodiments, the patient-worn health system isconfigured (both physically and digitally) for each individual user, anda set of programs may be calibrated specifically for the user. In otherscenarios, a loose fitting AR device may be used comfortably by avariety of users. For example, in some embodiments, the patient wornhealth system knows one or more of the distance between the user's eyes,the distance from the head worn display and the user's eyes, a curvatureof the user's forehead, the distance to the ears, or the height of thebridge of the nose for correct fitting purposes. All of thesemeasurements may be used to provide the right head-worn display systemfor a given user. In some other embodiments, such measurements may notbe necessary in order to perform the ophthalmic functions.

For example, referring to FIG. 4A-4D, the health system may becustomized for each user. The user's head shape 402 may be taken intoaccount when fitting the head-mounted patient-worn health system, in oneor more embodiments, as shown in FIG. 4A. Similarly, the eye components404 (e.g., optics, structure for the optics, etc.) may be rotated oradjusted for the user's comfort both horizontally and vertically, orrotated for the user's comfort, as shown in FIG. 4B. In one or moreembodiments, as shown FIG. 4C, a rotation point of the head set withrespect to the user's head may be adjusted based on the structure of theuser's head. Similarly, the inter-pupillary distance (IPD) (i.e., thedistance between the user's eyes) may be compensated for, as shown inFIG. 4D.

In the context of patient-worn health systems, this aspect of thehead-worn devices may be advantageous because the system already has aset of measurements about the user's physical features (e.g., eye size,head size, distance between eyes, etc.), and other data that may be usedin therapy and diagnosis of the patient.

In addition to the various measurements and calibrations performed onthe user, the patient-worn health system may be configured to track aset of biometric data about the user for patient identification andsecure communications. For example, the system may perform irisrecognition and/or retinal matching for patient identification, trackeye movements, eye movement patterns, blinking patterns, eye vergence,fatigue parameters, changes in eye color, changes in focal distance, andmany other parameters, that may be used in providing an opticalaugmented reality experience to the user. In the case of AR devices usedfor healthcare applications, it should be appreciated that some of theabove-mentioned aspects may be part of generically-available AR devices,and other features may be incorporated for particular health-relatedapplications.

Referring now to FIG. 5, the various components of an examplepatient-worn health display device will be described. It should beappreciated that other embodiments may have additional or fewercomponents depending on the application (e.g., a particular diagnostictool) for which the system is used. Nevertheless, FIG. 5 provides abasic idea of some of the various components and types of biometric datathat may be collected and stored through the patient-worn health systemor AR device. FIG. 5 shows a simplified version of the head-mountedhealth system 62 in the block diagram to the right for illustrativepurposes.

Referring to FIG. 5, one embodiment of a suitable user display device(62) is shown, comprising a display lens (106) that may be mounted to auser's head or eyes by a housing or frame (108), which corresponds tothe frame (64) (FIGS. 3A-3D). The display lens (106) may comprise one ormore transparent mirrors positioned by the housing (108) in front of theuser's eyes (20) and configured to bounce projected light (38) into theeyes (20) and facilitate beam shaping, while also allowing fortransmission of at least some light from the local environment. Asillustrated, two wide-field-of-view machine vision cameras (16) arecoupled to the housing (108) to image the environment around the user;in one embodiment these cameras (16) are dual capture visiblelight/non-visible (e.g., infrared) light cameras.

With continued reference to FIG. 5, a pair of scanned-lasershaped-wavefront (i.e., for depth) light projector modules with displaymirrors and optics configured to project light (38) into the eyes (20)as shown. The depicted embodiment also comprises two miniature infraredcameras (24) paired with infrared light sources (26, such as lightemitting diodes “LED”s), which are configured to be able to track theeyes (20) of the user to support rendering and user input. The system(62) further features a sensor assembly (39), which may comprise X, Y,and Z axis accelerometer capability as well as a magnetic compass and X,Y, and Z axis gyro capability, preferably providing data at a relativelyhigh frequency, such as 200 Hz. The depicted system also comprises ahead pose processor (36), such as an ASIC (application specificintegrated circuit), FPGA (field programmable gate array), and/or ARMprocessor (advanced reduced-instruction-set machine), which may beconfigured to calculate real or near-real time user head pose from widefield of view image information output from the capture devices (16).

Also shown is a processor (32) configured to execute digital and/oranalog processing to derive pose from the gyro, compass, and/oraccelerometer data from the sensor assembly (39). The depictedembodiment also features a GPS (37, global positioning satellite)subsystem to assist with pose and positioning analyses. In addition, theGPS may further provide remotely-based (e.g., cloud-based) informationabout the user's environment. This information may be used fordiagnostic purposes. For example, if the user is situated in an areahaving high pollen in the surrounding air, this information may beuseful to diagnose and/or treat a particular ailment. Or, in anotherexample, information about air pollution in a particular air may beadvantageously used when considering treatment options for a particularuser. Other types of information (e.g., pollen count, pollution,demographics, environmental toxins, interior climate and air qualityconditions, lifestyle statistics, proximity to health-care providers,etc.) may be similarly used in one or more applications.

The depicted embodiment may also comprise a rendering engine (34) thatmay feature hardware running a software program configured to providerendering information local to the user to facilitate operation of thescanners and imaging into the eyes of the user, for the user's view ofthe world. The rendering engine (34) is operatively coupled (105, 94,100/102, 104; i.e., via wired or wireless connectivity) to the sensorpose processor (32), the image pose processor (36), the eye trackingcameras (24), and the projecting subsystem (18) such that rendered lightis projected using a scanned laser arrangement (18) in a manner similarto a retinal scanning display. The wavefront of the projected light beam(38) may be bent or focused to coincide with a desired focal distance ofthe projected light.

The cameras (24) (e.g., mini infrared cameras) may be utilized to trackthe eyes to support rendering and user input (i.e., where the user islooking, at what depth he or she is focusing; as discussed below, eyeverge may be utilized to estimate depth of focus). The GPS (37), gyros,compass, and accelerometers (39) may be utilized to provide coarseand/or fast pose estimates. The camera (16) images and pose, inconjunction with data from an associated cloud computing resource, maybe utilized to map the local world and share user views with othersand/or a virtual or augmented reality community and/or healthcareproviders. In one or more embodiments, the cameras (16) may be used toanalyze food, drug, nutrients and toxins that the user intakes as partof a comprehensive health-care and/or wellness system or health-caresurveillance system.

With continued reference to FIG. 5, the display device (62) may includea medication dispensing module (21) to deliver medication to the user.The medication dispensing module (21) may include one or more outlets(22) and at least one medication container (23), which may be areservoir storing the medication to be dispensed out through the outlets(22). The outlet (22) may be connected to the container (23) by one ormore channels (22 a), which convey the medication (e.g., a liquid orgas) from the container (23) to the outlets (22). In some embodiments,the outlets (22) may simply be openings in the frame (108), or may benozzles attached to or integral with the frame (108). In someembodiments, the nozzles may be atomizers. In some embodiments, thechannels (22 a) are formed by openings in the frame (108) and/or tubing.

In one or more embodiments, the display device may comprise a lightemitting module (27) to selectively administer light to the wearer, suchas for treatment of the wearer's eyes based on a treatment protocol. Thelight emitting module (27) may comprise a light source, which mayinclude a light emitter emitting polychromatic polarized light, a laser,a light-emitting diode, a fluorescent lamp, a dichroic lamp, a fullspectrum light source, etc. In some embodiments, one light emittingmodule (27) may be provided for both eyes. In some other embodiments,the display device may include multiple light emitting modules (27), andeach eye may have at least one light emitting module configured todirect light to that eye.

While much of the hardware in the display system (62) featured in FIG. 5is depicted directly coupled to the housing (108) which is adjacent thedisplay (106) and eyes (20) of the user, the hardware componentsdepicted may be mounted to or housed within other components, such as abelt-mounted component, as shown, for example, in FIG. 3D. In addition,as noted herein, multiple sensors and other functional modules are showntogether for ease of illustration and description. It will beappreciated, however, that some embodiments may include only one or asubset of these sensors and/or modules.

In one embodiment, all of the components of the system (62) featured inFIG. 5 are directly coupled to the display housing (108) except for theimage pose processor (36), sensor pose processor (32), and renderingengine (34), and communication between the latter three and theremaining components of the system may be by wireless communication,such as ultra-wideband, or by wired communication. The depicted housing(108) preferably is head-mountable and wearable by the user. It may alsofeature speakers (e.g., speakers (66), FIGS. 3A-3D), such as those whichmay be inserted into the ears of a user and utilized to provide sound tothe user.

Regarding the projection of light (38) into the eyes (20) of the user,in some embodiment, the cameras (24) may be utilized to measure wherethe centers of a user's eyes (20) are geometrically verged to, which, ingeneral, coincides with a position of focus, or “depth of focus”, of theeyes (20). A 3-dimensional surface of all points the eyes verge to iscalled the “horopter”. The focal distance may take on a finite number ofdepths, or may be infinitely varying. Light projected from the vergencedistance appears to be focused to the subject eye (20), while light infront of or behind the vergence distance is blurred.

Further, without being limited by theory, it has been discovered thatspatially coherent light with a beam diameter of less than about 0.7millimeters is correctly resolved by the human eye regardless of wherethe eye focuses; given this understanding, to create an illusion ofproper focal depth, the eye vergence may be tracked with the cameras(24), and the rendering engine (34) and projection subsystem (18) may beutilized to render all objects on or close to the horopter in focus, andall other objects at varying degrees of defocus (i.e., usingintentionally-created blurring). Preferably the system (62) renders tothe user at a frame rate of about 60 frames per second or greater. Asdescribed above, preferably the cameras (24) may be utilized for eyetracking, and software may be configured to pick up not only vergencegeometry but also focus location cues to serve as user inputs.Preferably, such a display system is configured with brightness andcontrast suitable for day or night use.

In some embodiments, the display system preferably has latency of lessthan about 20 milliseconds for visual object alignment, less than about0.1 degree of angular alignment, and about 1 arc minute of resolution,which, without being limited by theory, is believed to be approximatelythe limit of the human eye. The display system (62) may be integratedwith a localization system, which may involve GPS elements, opticaltracking, compass, accelerometers, and/or other data sources, to assistwith position and pose determination; localization information may beutilized to facilitate accurate rendering in the user's view of thepertinent world (e.g., such information would facilitate the glasses toknow where they are with respect to the real world). Having describedthe general components of some embodiments of a user-worn heath system,e.g., an ophthalmic system, additional components and/or featurespertinent to healthcare and diagnostics will be discussed below. Itshould be appreciated that some of the features described below will becommon to various embodiments of the user-worn health system or manyembodiments of AR systems used for health purposes, while others willrequire additional or fewer components for health diagnostics andtreatment purposes.

In some embodiments, the user-worn health system is configured todisplay one or more virtual images based on the accommodation of theuser's eyes. Unlike prior 3D display approaches that force the user tofocus where the images are being projected, in some embodiments, theuser-worn health system is configured to automatically vary the focus ofprojected virtual content to allow for a more comfortable viewing of oneor more images presented to the user. For example, if the user's eyeshave a current focus of 1 m, the image may be projected to coincide withthe user's focus. Or, if the user shifts focus to 3 m, the image isprojected to coincide with the new focus. Thus, rather than forcing theuser to a predetermined focus, the user-worn health system or AR displaysystem of some embodiments allows the user's eye to a function in a morenatural manner.

Such a user-worn health system may eliminate or reduce the incidences ofeye strain, headaches, and other physiological symptoms typicallyobserved with respect to virtual reality devices. To achieve this,various embodiments of the patient-worn health system are configured toproject virtual images at varying focal distances, through one or morevariable focus elements (VFEs). In one or more embodiments, 3Dperception may be achieved through a multi-plane focus system thatprojects images at fixed focal planes away from the user. Otherembodiments employ variable plane focus, wherein the focal plane ismoved back and forth in the z-direction to coincide with the user'spresent state of focus.

In both the multi-plane focus systems and variable plane focus systems,the patient-worn health system may employ eye tracking to determine avergence of the user's eyes, determine the user's current focus, andproject the virtual image at the determined focus. In other embodiments,the user-worn health system comprises a light modulator that variablyprojects, through a fiber scanner, or other light generating source,light beams of varying focus in a raster pattern across the retina.Thus, the ability of the display of the health system to project imagesat varying focal distances not only eases accommodation for the patientto view objects in 3D, but may also be used to compensate for patientocular anomalies, as will be described in further detail below. In someother embodiments, a spatial light modulator may project the images tothe user through various optical components. For example, as describedfurther below, the spatial light modulator may project the images ontoone or more waveguides, which then transmit the images to the user.

Referring now to FIG. 6, an example process flow for projecting one ormore virtual images based on the user's accommodative reflex will bebriefly described. At 602, the system may determine a vergence of theuser's eyes through an eye tracking system. At 604, the system mayestimate a current focus of the user's eyes based on the determinedvergence. It should be appreciated that other embodiments of the ARsystem (or health system) may not necessarily utilize eye tracking, andimages may be sequentially displayed at a rapid pace to give aperception of 3D. Thus, the process flow of FIG. 6 should not be seen aslimiting, and is only provided for illustrative purposes.

If the health system utilizes a multi-depth plane display system (i.e.,light is projected at multiple fixed depth planes), the system may at608 determine a focal plane closest to the estimated focus based on eyevergence and accommodation. It will be appreciated that accommodationmay be measured by, e.g., use of an autorefractor, or other devicescompatible with the display system. At 610, the health system mayproject at least a portion of an image at the determined focal plane.

If the health system utilizes a variable-depth plane display system(i.e., one or more focal planes at which virtual content is projectedmay be moved back and forth in the z direction), at 612, the focus ofthe system, through a VFE, is varied to coincide with the estimatedfocus. At 614, the health system may project at least a portion of animage at the focal plane. Similarly, other embodiments of health systemsmay use other 3D image generating techniques to provide a comfortable,accommodative reflex-friendly projection of virtual objects to the user.

Although, in some embodiments, images are displayed based on theprojection of light associated with virtual images into the user's eye,light of any wavelength may be similarly projected into the user's eye.In addition to visible light, infrared light, or other light forms maybe similarly projected through the patient-worn health system. Thisaspect of the patient-worn health system may also be similarly used forcompensating health anomalies, as will be described below.

It should also be appreciated that although various embodiments aredescribed in which light is projected into the user's eyes, in one ormore embodiments, the health system may also receive light emitted fromthe user's eyes. In one or more embodiments, the light source for thehealth system may be a fiber scanning device (FSD) that projects lightin various patterns (e.g., raster scan, spiral scan, Lissajous, etc.)into the user's eye. Similarly, other light sources (e.g., OLED, DLP,LCD, etc.) may be similarly used in other embodiments of the healthsystem. In addition to projecting light, the FSD, in one or moreembodiments, may receive emitted light. The same fibers that projectlight may be used to receive light. In this mode, the health system mayfunction as a multi-depth scanner that multiplexes outputted modulatedlight waves with sensed or captured light waves. In some embodiments,the fiber scanner may be used in conjunction with, or in place of, thecamera (24) (FIG. 5) to, e.g., track or image the user's eyes. In one ormore embodiments, rather than the FSD being configured to receive light,the health system may have a separate light-receiving device to receivelight emitted from the user's eyes, and to collect data associated withthe emitted light. Thus, in one or more embodiments, this emitted light,and corresponding data may be analyzed to diagnose or treat anomalies,as will be discussed below.

Various details of a fiber scanning display device will now be discussedwith reference to FIGS. 28A-28C. Referring to FIG. 28A, a gradientrefractive index, or “GRIN”, lens 354 is shown fused to the end of asingle mode optical fiber. An actuator 350 (such as a piezoelectricactuator) is coupled to a fiber 352 and may be used to scan the fibertip.

Referring to FIG. 28B, a multicore fiber 362 may be scanned (such as bya piezoelectric actuator 368) to create a set of beamlets with amultiplicity of angles of incidence and points of intersection which maybe relayed to the eye 58 by a waveguide (370). Thus in one embodiment acollimated lightfield image may be injected into a waveguide, andwithout any additional refocusing elements, and that lightfield displaymay be translated directly to the human eye.

Display systems have been created in the past that use eye or gazetracking as an input, and to save computation resources by only creatinghigh resolution rendering for where the person is gazing at the time,while lower resolution rendering is presented to the rest of the retina;the locations of the high versus low resolution portions may bedynamically slaved to the tracked gaze location in such a configuration,which may be termed a “foveated display”.

An improvement on such configurations may comprise a scanning fiberdisplay with pattern spacing that may be dynamically slaved to trackedeye gaze. For example, with a typical scanning fiber display operatingin a spiral pattern, as shown in FIG. 28C (the leftmost portion 510 ofthe image in FIG. 28C illustrates a spiral motion pattern of a scannedmulticore fiber 514; the rightmost portion 512 of the image in FIG. 28Cillustrates a spiral motion pattern of a scanned single fiber 516 forcomparison), a constant pattern pitch provides for a uniform displayresolution.

It will be appreciated that, in addition to displaying images or actingas an imager, the display system may provide illumination for imagingthe eye or its surrounding tissue. In one or more embodiments, thehealth system may comprise an optical scanning or optical sensing moduleto allow the device to scan an anterior and interior portion of the eyeusing known visible and non-visible light spectrum techniques includingvisible imagery, photo-refraction, optical coherence tomography (OCT)and light field microscopy (LFM). In one or more embodiments, theophthalmic system may further comprise a light field imaging module tocapture multiple images of the eye at different focal lengthssimultaneously. It should be appreciated that the display, e.g., a FSD,may be advantageously configured such that the multiple frequencies oflight may be simultaneously emitted by the display. For example, the FSDmay include a single core fiber or may include multicore fibers, whichmay advantageously emit multiple frequencies of light simultaneously.

In the context of health-care and diagnostics, the type, frequency,color-scheme, placement, etc. of one or more images presented to theuser may be advantageously manipulated for diagnoses and treatment ofone or more disorders. For example, certain ailments may requirestrengthening of one eye in relation to the other. To this end, atreatment protocol may be devised in order to “train” the weak eye, byproviding increased stimulation to the weak eye in comparison to thestrong eye, for example. Or, in another example, a particular portion ofthe retina may have decreased sensitivity due to macular degeneration;to counter this, images may be modulated, or re-formatted and projectedto the peripheries of the retina, thereby compensating for the user'sdecreased field of vision. Thus, as will be described in further detailbelow, the ability of the health system to modulate a number ofparameters related to virtual image projection may be used to diagnoseand/or treat certain health anomalies.

Additionally, using the various principles outlined above, the healthsystem may be designed to provide diagnosis using astimulus-response-measurement analysis process. Devices such as thesemay either be used by a clinician, or in other embodiments, certainailments may simply be “diagnosed” or have symptoms acknowledged by thepatient (e.g., eye fatigue, dry eye, hypertension, onset of stroke orseizures etc.). This may crucially help the user to actively takecontrol of his/her health and prevent the onset of diseases byproactively taking care of them at the onset of certain symptoms. Suchdiagnoses may be made by analyzing contemporaneous data with historicaldata related to one or more tracked biometric parameters andenvironmental changes. In one or more embodiments, the health system mayalso be configured to provide informational cues, to send alerts to theuser and/or doctor or others, or assisting in other response means.

It should be appreciated that the health system may be configured to beautonomous (i.e., provide results directly to the user or other personor entity without input or control from a clinician or other person) orsemi-autonomous (i.e., some degree of input or control from theclinician or other person. In other embodiments, the health system maybe completely controlled by the clinician or other person, e.g., in anetworked or an all remotely based (e.g., cloud-based) implementation(e.g., software-controlled implementation of the health system fordiagnosing, monitoring, or treating the user, or in an implementation inwhich the health system is worn by the clinician to examine a patient.

As discussed in relation to FIG. 5, the health system may be designedwith a number of additional health-related sensors, in one or moreembodiments. The health system may include many sensors (e.g.,accelerometers, gyroscopes, temperature sensors, pressure sensors, lightsensors, non-invasive blood glucose sensors, ETCO2, EEG, and/or otherphysiological sensors, etc.) to monitor one or more physiologicalresponses of the user.

As described herein, the health system comprises an eye-tracking module,in one or more embodiments. The eye tracking module may be configured todetermine the vergence of the user's eyes in order to determine what theappropriate normal accommodation would be (through the directrelationship between vergence and accommodation) for the projection ofone or more virtual images, and may also be configured to track one ormore eye-related parameters (e.g., position of the eye, eye movements,eye patterns, etc.). This data may be used for several health-relateddiagnoses and treatment applications as will be described below.

As is apparent from the description herein, the health system may beused for diagnosis, monitoring, and therapy, which can includeeye-related diagnosis, monitoring, and therapy. In such eye-relatedapplications, the health system may be referred to as an ophthalmicsystem. As is also apparent from the description herein, the user (orwearer) of the device may be referred to as the patient where thediagnosis, monitoring, and therapy are conducted on that user by thedevice. In some other embodiments, the user may be a clinician and thepatient is a third party, who may be evaluated are treated by the user.It will also be appreciated that the diagnosis and monitoring may bereferred to generally as health analysis.

Myopia/Hyperopia/Astigmatism

Having described the various components of the ophthalmic system in thecontext of healthcare diagnoses and treatments, embodiments of using theophthalmic system to compensate for common eye-related ailments will bedescribed below. It should be appreciated that the embodiments below arefor illustrative purposes only, and should not be seen in a limitinglight. For example, the embodiments described herein may also beapplicable to other non-ophthalmic systems as well.

Vision defects such as short-sightedness (e.g., myopia) andfar-sightedness (e.g., hyperopia), astigmatisms, etc. are very common inthe general population. Often, these defects are corrected throughcorrective lenses. In one or more embodiments, the optics of theophthalmic system may be modulated in order to naturally compensate fora user's vision defects. In one or more embodiments, the ophthalmicsystem may be configured to automatically or interactively determine(e.g., during a setup process or later) an optical prescription of auser and incorporate the optical prescription in the optical sub-partsof the ophthalmic system. The optical prescription may be determinedduring initialization of the ophthalmic system, calibration of thesystem, as part of an eye-prescription configurator program (e.g.,phoropter or other visual acuity examination as described herein), or atany time during use of the ophthalmic system. Biometric data may be usedto identify a user and associated optical prescription. In variousembodiments, the wavefront of the light projected into the user's eyemay be modified based on the determined prescription. In otherembodiments, alternatively or in combination, the wavefront of ambientlight in front of the user, for example, light that is passed from thesurrounding world in front of the user through the ophthalmic system tothe user's eye, is modified to provide optical correction. Accordingly,the user's optical prescription, and changes therein, may be used tomake real-time changes to the user's incoming lightfield, and may beconfigured to correct for one or more optical defects or aberrations.One non-limiting advantage of the embodiments described herein, is thatthe ophthalmic system may be configured to dynamically correct visiondefects as a user's vision changes over time, for example, 2, 3, 4, 6,or more times a year without requiring replacement or substitution ofparts into the system. Rather, the parts can be dynamically reconfiguredelectrically during use of the ophthalmic device in real-time based onchanges to the user's vision (e.g., the optical prescription).

For example, in the case of myopia, light associated with one or moreobjects is focused in front of the retina, as shown in FIG. 7A, ratherthan onto the retina. This causes the objects to appear out of focus.Referring now to FIG. 7B, a concave lens can be used to compensate forthe disorder, changing the nature of the incoming light, and causing thelight to be focused on the retina.

In one or more embodiments, once an optical prescription of the user hasbeen determined, a desired power spherical wavefront curvature (e.g., anegative power spherical wavefront curvature) may be encoded into theoptics of the ophthalmic system to correct for the user's opticalprescription. For example, the phrase “encode into the optics” may referto applying a voltage to an electrode of an adaptable optic (e.g., inthe embodiment employing adaptable optics), where the voltage to beapplied to the electrode and the voltage applied thereto is determinedbased on the desired compensating wavefront to correct for refractiveerrors in the eye. Or, in the embodiment of a waveguide stack, thephrase “encode into the optics” may refer to selectively addressing awaveguide to direct light to a proper focal depth for a certain portionof the eye to generate a compensating wavefront to correct forrefractive errors in the eye. In some embodiments, a negative powerspherical wavefront is encoded into the optics of the ophthalmic systemto correct for a user's lower order aberration (e.g., defocus), such asfor correcting myopia. In an augmented reality display system, suchcorrection may be applied to ambient light from the surrounding world,e.g., in front of the user, similar to a pair of glasses. Or, in someembodiments, either in combination or alternatively, the correction maybe applied by modifying an image projected by a display in theophthalmic system to the eye of the user (e.g., by the processor of theophthalmic system) with the appropriate negative spherical wavefront.The phase of the projected image may thus be modified such that theprojected image appears to be in focus and corrected based on theoptical prescription.

In the case of hyperopia, light associated with one or more objects isfocused behind the retina, as shown in FIG. 8A, rather than on theretina. This causes the objects to appear out of focus. Referring now toFIG. 8B, a convex lens can be used to compensate for the disorder.

In one or more embodiments, once the optical prescription has beendetermined, a compensating spherical wavefront (e.g., a positive powerspherical wavefront) may be encoded into the optics of the ophthalmicsystem. In some embodiments, a positive power spherical wavefront isencoded into the optics of the ophthalmic system to correct for a user'slower order aberration (e.g., defocus), such as for correctinghyperopia. Such correction may be applied to modify ambient light fromthe world surrounding the user, e.g., in front of the user. Or, asdescribed above, the processor may apply the corrected wavefront tomodify the image projected by the ophthalmic system based on thedetermined prescription such that the projected image appears to be infocus and corrected based on the optical prescription. Again, acombination of both may be used in an augmented reality system.

Astigmatism is a condition wherein light coming into the eye isimproperly or partially focused onto the retina. As is schematicallyillustrated in FIG. 9A, the shape of the eye may be misshaped (usuallycaused by an irregularly shaped cornea) which causes the resulting imageto be both out of focus and distorted. For example, the curvature alonga meridian may be different than the curvature along a perpendicularmeridian. Referring now to FIG. 9B, the ophthalmic device may correctastigmatism by applying an appropriate level of compensating wavefrontcurvature correction, e.g., along the appropriate transverse axis of themeridian.

More particularly, in various embodiments, once the appropriate opticalprescription has been determined, the appropriate compensating wavefrontcorrection may be encoded into the optics of the ophthalmic. A wavefront(e.g., a 4D wavefront) that is incident on the optics of the ophthalmicsystem may be modified (e.g., modify the phase of the incidentwavefront) by the optics to generate a compensating wavefront that isincident on the eye of the user to correct for defects in the eye. Inother words, the optics of the ophthalmic system (e.g., an adaptableoptics as described below) may be configured to vary the focus and/orwavefront of the light reaching the user's eye based on, for example,the refractive error of the eye, the shape of the user's eye, e.g., theshape of the cornea and/or the lens in the eye, the length of the user'seye (e.g., the length of the eye's natural optics transmission to theretina), etc. In some embodiments, the compensating wavefront may modifythe phase of the wavefront incident on the optics of the ophthalmicdevice.

In some embodiments, higher order aberrations may be difficult tocompensate for by spherical wavefront correction as described above.Thus, in some embodiments, multiple, independently controllable lensesmay be controlled by the ophthalmic system to form a complex lens thatmay correct for higher order aberrations, as described below. In otherembodiments, alternatively or in combination, the ophthalmic system maybe configured to retrieve a known aberration pattern based on theprescription of a user and apply this pattern to an image stored in theophthalmic system to be presented to the eye of the user.

For example, the ophthalmic system may store one or more images that maybe retrieved by the ophthalmic system. In some embodiments, the imagesmay be pre-loaded or generated by the ophthalmic system. In someembodiments, the images may be part of a moving image (e.g., a video).In other embodiments, the images may be feed from another sourceexternal to the ophthalmic system (e.g., remote data repository (72)).In other embodiments, alternatively or in combination, the images may beobtained based on ambient light in front of the ophthalmic system, asdescribed herein. The image may be projected by the ophthalmic system tothe user, and may be modified by the software included in the ophthalmicsystem. The ophthalmic system may generate one or more 2D images to bepresented to the eye of a user, and the system may be configured tomodify these images prior to projecting the images based on the opticalprescription of the user. In some embodiments, as described below for anembodiment of the ophthalmic system comprising a waveguide stack,different image content projected at different focal depths provides theuser a 3D perception of images. Thus, each image may be a 2Drepresentation of an image at a different focal depth. Each image may bemodified individually by software included in the ophthalmic system. Forexample, the pattern or collection of pixels that form each image can bemodified to counter, offset, or reduce effects of errors introduced bythe eye.

For example, defects in the retina of a user's eye may result in errorsas to the intensity, shape, magnification, or color viewed by the user.In various embodiments, the wavelength of light or intensity of light ofan image projected by the ophthalmic system may be modified to accountfor color blindness in the eye of the user. For example, the wavelengthof the light presented to the user may be changed based on the colorblindness prescription to compensate for the color blindness. In someembodiments, modification of the 2D images (e.g., each of which may be a2D representation of an image at different focal depths) may be employedto correct for dead spots or weak spots in the eye. For example, bymapping the eye to determine dead/weak spots, the intensity of light ofa projected image may be increased for identified areas of the eye orretina having dead or weak spots. Thus, in some embodiments,modification of the image may be performed by modifying the intensity ofone or more portions of the image to be presented. For example, a fiberscanning display or a spatial light modulator included in the ophthalmicsystem may vary intensity while generating the image.

Another example of modifying an image comprises modification of theintensity pattern of the image. For example, if it is known that theimage viewed by the user will exhibit radial distortions (e.g., barrel,pincushion, or mustache distortions) a compensating distortion may beapplied to the image to correct for such distortions. The distortionssought to be corrected may be a result of either refractive errors inthe eye or by the optics of the ophthalmic system, thus would be knownby the optical prescription, or the ophthalmic system. Thus, theophthalmic system may modify the intensity pattern of a projected imageto compensate for the refractive errors. For example, if a user's eyewere to introduce pincushion distortion to the image, the ophthalmicsystem may be configured to modify the intensity pattern of the imageprojected to the user via the display to include barrel distortion in anamount so as to cancel out or reduce the amount of pincushion distortionin the image on the retina, which is the opposite of pincushiondistortion. Similarly, the ophthalmic system may be configured modifythe image by adding pincushion distortion to the intensity patternmaking up the image on the display if the user's eye introduced barreldistortion. In some embodiments, the modification of the image may bedone to correct for fisheye distortions by altering the image presentedby the display by applying a distortion of opposite angle and amount.

In various applications, a combination of wavefront correction andmodification of an image generated by the ophthalmic system (e.g.,modification of the intensity pattern comprising the image) may be usedto compensate for the astigmatism or any other defect in the user's eye.

In some embodiments, the ophthalmic system may be a patient-wornophthalmic device as illustrated in FIGS. 3A-3D and 5 that may beimplemented for correcting vision defects like myopia, hyperopia, andastigmatism. The ophthalmic device includes a display device (62) thatincludes a light source (18) configured to project light (38) that isdirected into the eyes of a user in a display lens (106) of the displaydevice (62). The ophthalmic device may also direct ambient light fromthe surrounding world, e.g., in front of the user, to the eyes of theuser through display lens (106). The display device (62) also comprisesone or more adaptable optics (e.g., variable focus elements or VFEs,electrically reconfigurable reflective or refractive optical elements,etc.). Such adaptable optics may be included in the display lens (106)or located between the display lens (106) and the light source (18) orbetween the display lens (106) and the eye or elsewhere in the path oflight to the eye. The adaptable optics or VFE is an optical element thatcan be dynamically altered, for example, by applying an electricalsignal thereto to change the shape of a wavefront that is incidentthereon. The adaptable optics may be a reflective optical element suchas a deformable mirror or a transmissive optical element such as adynamic lens (e.g., a liquid crystal lens, an electro-active lens, aconventional refractive lens with moving elements, amechanical-deformation-based lens, an electrowetting lens, anelastomeric lens, or a plurality of fluids with different refractiveindices). By altering the adaptable optics' shape or othercharacteristics, the wavefront incident thereon can be changed, forexample, to alter the focus of the wavefront as described herein toprovide optical correction.

In various embodiments, the ophthalmic device includes outward facingcameras configured to capture ambient light from the environmentsurrounding the user. For example, the ophthalmic device may include oneor more wide-field-of-view machine vision cameras (16) operativelycoupled to local processing module (70). These cameras may be configuredto image the environment around the user. In one embodiment thesecameras (16) are dual capture visible light/infrared light cameras.Images taken by cameras (16) may be stored in a digital memory of theophthalmic device and retrieved for subsequent processing. The imagesmay then be retrieved by the ophthalmic device, which may then re-renderthe obtained images to the user by projecting the images through displaydevice (62).

In various embodiments, the ophthalmic device may comprise a biofeedbacksystem configured to determine a comfort level of the user in viewing anobject or image. For example, if a user's eyes are shifting, changingaccommodation, changing pupil size, changing vergence, etc., these maybe indicators that the user is unable to comfortably view an object orimage. In some embodiments, changes in accommodation or behaviorassociated with accommodation may be represented as an unsteady, randomfluctuation, instability and/or oscillation in the accommodation orbehavior of the eye. Instability or oscillation in accommodation orbehaviors associated with accommodation may be a sign that the user isstruggling with focusing on or accommodating on an object or image.Accordingly, the biofeedback system may receive real-time inputsrelating to the state or properties of the user's eye.

In various embodiments, the ophthalmic device includes one or more eyetracking cameras or other cameras or imaging systems to track one ormore eyes of the user. For example, some embodiments may utilize cameras(24) (e.g., infrared cameras) paired with light sources (26) (e.g.,infrared light sources) configured to monitor and track the eyes of theuser. These cameras and sources can be operatively coupled to the localprocessing module (70). Such cameras and/or imaging systems can monitorthe orientation of the eyes, pupil size of the eyes, vergence of theeyes, and the corresponding direction of the line of sight of therespective eyes. As described below in connection with phoroptertechnology, the cameras (24) may be configured to determineaccommodation of the eyes of the user. In some embodiments, the cameras(24) may be configured to determine the convergence point of the eyes,as described above in reference to FIGS. 5 and 6.

In some embodiments, the ophthalmic device comprises gyroscopic sensors,accelerometers, other sensors, or a combination thereof to monitorchanges in the head position, head pose or orientation. In someembodiments, the display device (62) may comprise a sensor assembly (39)configured to detect movement imparted onto and orientation of thedisplay device (62) due to movement of the user's head. The biofeedbacksystem may be configured to receive the detected head movement, and ifthe frequency and/or magnitude of movement is beyond a threshold, thesystem may be configured to determine that the user is unable tocomfortably view the image. For example, constant head movement may beindicative of a searching for a comfortable viewing position of theimage. If such signs are present that the person may not be focusingwell, then the ophthalmic system may be configured to alert the user ofsuch, perform a phoropter test or other vision test, or may objectivelyand automatically evaluate the user's prescription to improve visionquality.

In some embodiments, the adaptable optics may be operatively coupled toa local processing module (70) and configured to compensate for visiondefects of the wearer as shown in FIG. 3C. The local processing module(70) may store the one or more optical prescriptions of the user. Or, insome embodiments, the local processing module (70) may store one or moreimage modification programs (e.g., programs configured to modify animage presented to the wearer) that correspond to one or more opticalprescriptions. The local processing module (70) may be configured toencode the appropriate compensating wavefront into the adaptable opticsof the display device (62) and/or modify the image generated by theophthalmic system based on an optical prescription and/or an imagemodification program. For example, as will be described in greaterdetail below with reference to FIGS. 10A and 11, the local processingmodule (70) may execute logic devices configured to modify the VFE oradaptable optics to generate a corrected wavefront, based on the opticalprescription, of an image generated by the ophthalmic device and/orambient light presented to the eye of the use.

In some embodiments, the ophthalmic device may include one or moretransmitters and receivers to allow transmission and reception of databetween the ophthalmic device and the remote processing module (72)and/or remote data repository (74). In some embodiments, any of theprocessing steps executed by the local processing module (70) anddigital memory therein may be performed remote from the user by remoteprocessing module (72) operatively coupled to remote data repository(74).

In some embodiments, the display device (62) includes one or more VFE oradaptable optics included with the display lens (106). For example, theVFE or adaptable optics may be included with a waveguide stack, asdescribed in connection with FIG. 10E. For example, the VFE or adaptableoptics (316 a, 316 b) may be disposed between the surrounding world andthe waveguide stack or between the user and the waveguide stack. Thus,the VFE or adaptable optics may be configured to modify the wavefront ofprojected light (38) that produces the image generated by the displaydevice (62) of FIG. 5 and/or the ambient light surrounding the user,e.g., in front of the user. In another embodiment, in the alternative orin combination, the VFE or adaptable optics may be disposed between thelight source, for example, the plurality of displays (200, 202, 204,206, 208), and the with the waveguide stack shown in FIG. 10E. In thiscase, the wavefront of the image generated by the ophthalmic system maybe modified without also modifying the wavefront of ambient light passedto the eye of the user.

The VFE or adaptable optics may be any optical element implemented tomodify the wavefront of the image. In various embodiments, the light(38) projected by the display is incident on one or more VFE oradaptable optics, and the VFE or adaptable optics may modify the phaseof the wavefront incident thereon. The modified wavefront may propagateto the user who perceives an image based on the modified wavefront. Inanother embodiment, the VFE or adaptable optics modify the ambient lightin front of the user to correct for vision defects experienced whenviewing the outside world. As described below. FIGS. 10B-10D illustrateexample configurations where VFE or adaptable optics as used in theophthalmic system as disclosed herein to correct for vision defects.However, it will be understood that other VFE or adaptable optics may beused.

The VFE or adaptable optics may achieve a variable focus and resultantwavefront modification by utilizing transmissive, refractive,diffractive, or reflective techniques. For example, the VFE or adaptableoptics may be a refractive element, such as a liquid crystal lens, anelectro-active lens, a conventional refractive lens with movingelements, a mechanical-deformation-based lens (such as a fluid-filledmembrane lens, or a lens akin to the human crystalline lens wherein aflexible element is flexed and relaxed by actuators), an electrowettinglens, or a plurality of fluids with different refractive indices. TheVFE or adaptable optic may comprise one or more lenses formed usingflexible and deformable elastomers (e.g., elastomeric lenses). Suchelastomeric lenses may be configured to receive a voltage applied toelectrodes disposed at different axes of the lens, the voltage mayimpart a strain along the axes thereby modifying the shape of the lensesand varying the optical power. The VFE or adaptable optics may alsocomprise a switchable diffractive optical element (such as one featuringa polymer dispersed liquid crystal approach wherein a host medium, suchas a polymeric material, has microdroplets of liquid crystal dispersedwithin the material: when a voltage is applied, the molecules reorientso that their refractive indices no longer match that of the hostmedium, thereby creating a high-frequency switchable diffractionpattern). Other arrangements are possible, as described below inconnection with FIGS. 10B-10E.

FIGS. 10B and 10C illustrate an example embodiment of adaptable optics.For example, the adaptable optics may comprise a variable focus element(VFE) (1020) (e.g., a deformable mirror membrane, any mirror-based VFE,deformable lens, elastomeric lens, phase modulator, etc., as describedabove). In some embodiments, the VFE (1020) may be integrated with orembedded in the display lens (106). In some embodiments, for example,one or more adaptable optical elements or VFEs (1020) may be integratedwith a stacked waveguide assembly and/or disposed on one or more sidesthereof.

FIG. 10B illustrates an example embodiment of modifying a shape of a VFE(1020) based on a shape of a cornea (1026) is illustrated. In order tocompensate for astigmatism, or any other comeal defect, the phase and/orfocus of the light displayed to the user may be modified based on theshape of the cornea (1026). For example, where the displayed imageincludes ambient light from the surroundings, e.g., in front of theuser, the focus of the light transmitted through the lens to the wearer(e.g., the focal depth) is modified in real-time, as the user movesabout the surroundings and light is transmitted through the lens to thewearer. In another embodiment, where the displayed image is an imagegenerated by the ophthalmic system to be displayed by the ophthalmicsystem as the user moves, the modification of the phase and/or focus ofthe light can be done on a per frame or per pixel basis, as the usermoves about the surroundings, based on the shape of the cornea (1026).For example, a wavefront correction may be applied to each frame of animage, and may be different between frames, and/or the wavefront may becorrected for each pixel of a display, which may be different betweenthe pixels. In one or more embodiments, the ophthalmic system maydetermine the refractive errors caused by the eye of the user, forexample, the shape of the user's cornea (1026), and modify a shape ofthe VFE (1020) based on the shape of the cornea. See, for example, thedescription below in connection with aberrometry and retinoscopytechnology. Although reference in this example is made to the shape ofthe cornea as the cause of the vision defect, correction can beperformed for other causes of refractive error.

Some VFEs such as deformable membrane (e.g., lens or mirror) VFEs (1020)are coupled to a set of electrodes (1022) that are then selectivelycontrolled in order to modify the shape of the membrane (e.g., lens ormirror), and consequently change the phase, wavefront shape, andpossibly the focus of the light. As shown in FIG. 10B, the electrodes(1022) may be controlled in a manner such that the shape of the VFE(1020) complements the shape of the cornea (1026) (or other refractiveerror) such that the image may be appropriately viewed by the user's eyeas shown in FIG. 10C. It should be appreciated that such techniques ofchanging the shape of the VFE (1020) for every frame (or every pixel)may be used for other applications such as other types of causes ofrefractive errors as detailed below as well, and the astigmatism exampleof FIG. 10C is an example only.

With reference to FIG. 10D, the VFE or adaptable optics can be includedwith a waveguide stack (178) and can be driven to compensate for theshape of a user's cornea or address any other refractive condition ofthe user. The optics illustrated in FIG. 10D comprises a stackedwaveguide assembly of transmissive beamsplitter substrates, each ofwhich is configured to project light at a different focal plane or as iforiginating from a different focal plane. For example, a first waveguidemay be configured to modify the wavefront of incident light by a firstoptical power while a second waveguide may modify the wavefront by asecond optical power. The first and second optical powers may bespherical wavefront corrections and they may be positive or negativecorrections. The first and second optical powers need not be the samedegree of correction or same direction of curvature correction. The VFEor adaptable optics of FIGS. 10D and 10E may be integrated with thedisplay lens (106) of FIG. 5 and configured to both project an imagegenerated by the ophthalmic system and permit ambient light to passthrough the waveguide stack to the user's eye.

The stacked waveguide assembly (178) may be utilized to providethree-dimensional perception to the eye/brain by having a plurality ofwaveguides (182, 184, 186, 188, 190) and a plurality of lenses (198,196, 194, 192) configured together to send image information to the eyewith various levels of wavefront curvature for each waveguide levelindicative of focal distance to be perceived for that waveguide level.In some embodiments, the plurality of lenses (198, 196, 194, 192) areweak lenses, however, it will be understood that lenses (198, 196, 194,192) are not to be limited to such and may be any lens suitable forproviding the desired properties of the waveguide stack (178). Aplurality of displays (200, 202, 204, 206, 208), or in anotherembodiment a single multiplexed display or reduced number of multiplexeddisplays, may be utilized to inject light, e.g., collimated light withimage information into the waveguides (182, 184, 186, 188, 190), each ofwhich may be configured to distribute incoming light substantiallyequally across the length of each waveguide, for exit down toward theeye.

In some embodiments, one or more of the plurality of lenses (198, 196,194, and 192) may be adaptable optics, as described above, configured toprovide for prescription correction in accordance with the embodimentsdescribed herein. In this case, the lenses (198, 196, 194, and 192) maybe adaptable optics that are dynamic, adaptable, or switchable, suchthat the shape and/or characteristics of these lenses may be altered toprovide refractive correction based on the prescription of the use. Forexample, the lenses (198, 196, 194, and 192) may comprise switchableadaptable optical elements, deformable lens such as an elastomeric lenswith electrodes as described herein, or VFEs of FIGS. 10B and 10C and orany of the transmissive lenses described herein.

The waveguide (182) nearest the eye may be configured to delivercollimated light, as injected into such waveguide (182), to the eye,which may be representative of the optical infinity focal plane. Theother waveguides may be configured to represent focal planes closer thaninfinity at a range of diopters, giving the user 3D perception of imagesgenerated by the ophthalmic system as different image content fromdifferent waveguides will appear to originate from different depths ordistances from the user.

For example, the next waveguide up (184) is configured to send outcollimated light which passes through the first lens (192; e.g., a weaklens, for example, a weak negative lens) before it can reach the eye(58); such first lens (192) may be configured to create a slight convexwavefront curvature so that the eye/brain interprets light coming fromthat next waveguide (184) as coming from a first focal plane closerinward toward the person from optical infinity. Similarly, the thirdwaveguide (186) passes its output light through both the first (192) andsecond (194) lenses before reaching the eye (58); the combined opticalpower of the first (192) and second (194) lenses may be configured tocreate another incremental amount of wavefront divergence so that theeye/brain interprets light coming from that third waveguide (186) ascoming from a second focal plane even closer inward toward the personfrom optical infinity than was light from the next waveguide (184).

The other waveguide layers (188, 190) and lenses (196, 198) aresimilarly configured, with the highest or furthest waveguide (190) inthe stack sending its output through all of the lenses between it andthe eye for an aggregate focal power representative of the closest focalplane to the person. To compensate for the stack of lenses (198, 196,194, 192) when viewing/interpreting light coming from the world (144) onthe other side of the stacked waveguide assembly (178), a compensatinglens layer (180) is disposed at the top or in front of the stack tocompensate for the aggregate power of the lens stack (198, 196, 194,192) below. Such a configuration provides as many perceived focal planesas there are available waveguide/lens pairings. Both the reflectiveaspects of the waveguides and the focusing aspects of the lenses may bestatic (i.e., not dynamic or electro-active or electrically switchable).In an alternative embodiment they may be dynamic using, for example,electro-active or electrically driven changes of features as describedabove. Such dynamic configurations can enable a small number ofwaveguides to be multiplexed in a time sequential fashion to produce alarger number of effective focal planes. In addition, such dynamicconfigurations can enable the dynamic correction of refractive errors ofthe user's eye.

As shown in 1050, the eye 58 is a normal eye having a normal cornea. Inthis case, the different waveguides interact with the eye/corneaproviding images at various focal planes. In the case of an abnormalcornea, as shown in 1060, the adaptable optics of each of the waveguidesmay be selectively addressed in order to complement the irregular shapeof the cornea. The adaptable optics of each waveguide may comprise areflective optical element such as a deformable membrane mirror or apartially or fully transmissive optical element such as a dynamic lens(e.g., a liquid crystal lens, an electro-active lens, a conventionalrefractive lens with moving elements, a mechanical-deformation-basedlens, an electrowetting lens, an elastomeric lens, or a plurality offluids with different refractive indices). For example, lenses of afirst waveguide may be identified to receive light of the wavefront ofan image from one of the plurality of displays. The lenses of anidentified waveguide may be selectively deformed or addressed to reflector pass the light while modifying the incident wavefront and generatinga desired wavefront curvature indicative of focal distance to correctfor the irregular shape of the cornea. Thus, the focus and/or thewavefront of the image may be carefully distorted/changed by selectingthe configuration of the lenses for each of the waveguides to produce anappropriate wavefront curvature to the user, thereby correcting for anyirregular shape of the cornea, length of the eye, irregular lens shapeor the refractive error of the eye or combination of those.

FIG. 10E illustrates example embodiments of arrangements of VFE oradaptable optics. In some embodiments, the ophthalmic system may includeboth the stacked waveguide assembly (178) of FIG. 10D and one or moreVFE or adaptable optics (1020) of FIGS. 10B and 10C as shown in FIG.10E. For example, the stacked waveguide assembly (178) may be embeddedin or integrated with the display lens (106). In some embodiments, a VFEor adaptable optics (1020) may also be embedded in or integrated withthe display lens (106). In one implementation, the VFE or adaptableoptics (1020) may be positioned between the stacked waveguide assembly(178) and the surrounding world (e.g., adaptable optics 316 a). Inanother implementation, the VFE or adaptable optics (1020) may bepositioned between the stacked waveguide assembly (178) and the user(e.g., adaptable optics 316 b). In yet another embodiment, one or moreVFEs or adaptable optics (1020) may be positioned between the stackedwaveguide assembly (178) and the plurality of displays (200, 202, 204,206, and 208). There may be a single VFE or adaptable optic (1020)between the stacked waveguide assembly (178) and all of the plurality ofdisplays (200, 202, 204, 206, and 208). Or, there may be multiple VFEsor adaptable optics (1020), for example, a VFE or adaptable optics(1020) for each of displays (200, 202, 204, 206, and 208) (e.g.,adaptable optics 316 d). The VFE or adaptable optics (1020) may bepositioned between the light source (18) and the waveguide stack (178)or may be integrated into the light source (18). The VFE (1020) oradaptable optics may be integrated in the waveguide stack (178). Inanother embodiment, the VFE or adaptable optics (1020) may be disposedbetween the one or more of the plurality of waveguides (182, 184, 186,188, 190) and configured to be altered so as to provide visioncorrection based on the optical prescription.

Accordingly, various embodiments of an ophthalmic system may include alight modulator configured to variably project light beams of varyingfocal depth, through a fiber scanner, or other light generating source,in a raster pattern across the retina. In this embodiment, theophthalmic system may be able to project images at varying focaldistances to compensate of vision defects, in a manner similar to thestacked waveguide assembly (178). Similarly, the light source may beconfigured to provide refractive correction to correct for myopia,hyperopia, or astigmatism based on the optical prescription of the user.In various embodiments, the ophthalmic system includes one or morespatial light modulators configured to modulate the phase of the lightand alter the shape of the wavefront to provide suitable opticalcorrection based on the user's prescription. Such phase modulator mayreceive light from the light source mounted on the ophthalmic system. Insome embodiments, the spatial light modulators are included in additionto the adaptable optics or VFEs described herein.

In some embodiments, the ophthalmic system may be an augmented realitysystem that uses AR and/or VR techniques to compensate for the shape ofa user's cornea and/or otherwise correct for vision defects. Forexample, the ophthalmic system may be an augmented reality head mounteddisplay system configured to pass light from the world in front of theuser of the augmented reality system into an eye of a person wearing theophthalmic system. In such embodiments, the ophthalmic system alsocorrects or modifies the wavefront of the lighted passed from the worldbased on an optical prescription of the person wearing the ophthalmicsystem. Such an ophthalmic device can also be configured to providewavefront correction to AR image content generated by the ophthalmicsystem and projected to the eye of the user. In this way, the ophthalmicsystem modifies the images content presented to the wearer to correctfor myopia, hyperopia, astigmatism, etc.

In another embodiment, in the alternative, the ophthalmic system is a VRhead mounted display system that is opaque and blocks the transmissionof ambient light formed in front of the user and the VR head mounteddisplay. The VR head mounted display may be configured to display onlyvirtual image content to the wearer or user. In some embodiments, whereambient light is formed in front of the user and thus is blocked by theVR head mounted display system, the VR head mounted display system may,however, include outward facing cameras (e.g., wide-field-of-viewmachine vision cameras (16)), which provide a view of the world in frontof the user. These cameras may capture the ambient light in front of theuser, reproduce images containing views of the world in front of theuser on the display, and project these images onto the eyes of the user.The virtual image content may be modified by a wavefront correctionbased on the optical prescription in a manner similar to the AR imagecontent of the augmented reality head mounted display system. Such asdescribed above, for example, one or more adaptable optics, such asshown in FIG. 10E, may be adjusted to provide suitable refractivecorrection. Such ophthalmic systems can be configured to providewavefront correction to the virtual reality image content. While the VRsystem is opaque to ambient light, VR image content may be any imagecontent stored in the memory or generated by the ophthalmic system,including images of ambient light in front of the user obtained by theoutward facing cameras.

Referring now to FIG. 10A, an example process flow of correcting visiondefects like myopia, hyperopia, and astigmatism is briefly discussed.The process flow 1000 is directed to modifying an image presented to theuser based on a prescription of the user. In some embodiments, processflow 1000 may be performed by patient-worn ophthalmic devices, such asthose described in connection with FIGS. 3A-3D. The process flow 1000can be implemented by the local processing module (70) configured toexecute logic devices in the local processing module (70). In anotherembodiment, local processing module (70) may implement process flow 1000via the remote processing module (72) executed by logic devices in thelocal processing module (70) operably connected to the remote datarepository (74). Adaptive optics such as electrically reconfigurablemirrors or lenses such as lenses located as shown in FIGS. 10B-10E maybe used to provide refractive correction based on the user's opticalprescription.

Referring now to process flow 1000, at 1002, the ophthalmic system maydetermine a prescription of the user. In one or more embodiments, theuser may simply provide the ophthalmic system with the information. Forexample, the user may input a prescription into a user interface. Or, inother embodiments, the ophthalmic system may go through aneye-prescription configurator program to manually and interactivelydetermine the user's prescription, as will be described further below.For example, the ophthalmic device may be pre-programmed with discretegranular steps in adjusting focus or altered wavefronts. Adjusting thefocus many include adjusting the focus on a first meridian and/or asecond meridian, where adjustment to one meridian may be independent ofadjustments to the other. The user may then specify a desired wavefront,which may define an optical prescription, to the ophthalmic systemthrough an appropriate feedback mechanism (e.g., a user interface). Or,in another embodiment, the user may have the option of incrementallyincreasing or decreasing a prescription (e.g., changing the focus and/orwavefront) until the user arrives at a comfortable viewing prescription.See, for example, the description below in connection with phoroptertechnology.

In another embodiment, the ophthalmic system may automatically andincrementally change the user's prescription in real-time, withoutrequiring user input, based tracking and monitoring the eyes via theeye-tracking system or other systems as described herein. In someembodiments, the ophthalmic system may utilize the biofeedback system toautomatically change the user's prescription. For example, if a user'seyes are shifting, unstable, oscillating, changing (e.g., in an unsteadyor random manner) accommodation, etc., these may be indicators that theuser is unable to comfortably view the object. Accordingly, thebiofeedback system may receive real-time inputs relating to the state ofthe user's eye. If a determination is made that the user is unable tocomfortably view the virtual reality content, augmented reality content,or real content from ambient light from in front of the user anddisplayed through the display device (62), then the ophthalmic systemmay automatically initiate an eye-prescription configurator program(e.g., phoropter, autorefractor, or other visual acuity examinations asdescribed herein).

In some embodiments, as described above, the biofeedback system mayutilize the eye-tracking system to provide real-time inputs related tothe eye of the user. For example, as described below in connection withphoropter technology, the eye tracking system may monitor theaccommodation state. The eye tracking system may detect a fluctuation(e.g., changes) in the accommodation of the eyes, for example, bycomparing multiple measurements. In some embodiments, the accommodationmay be monitored by monitoring the shape of the lens of one or moreeyes, vergence of the eyes, pupil size of one or more eyes, etc. In someembodiments, monitoring the accommodation state may comprise projectinga small image into the eye (e.g., a dot or multiple dots) and, usinginward facing cameras, monitor whether the image is focused on the foveaof the retina or changes position. For example, as described herein inconnection with autorefractor, phoropter, and SLO technologies.Fluctuations in accommodation may indicate an uncomfortable focal depthor blurred image. Thus, the ophthalmic system may increase or decreasethe prescription until the fluctuations cease or lessen, therebyarriving at a comfortable viewing prescription.

Similarly, the biofeedback system may also receive inputs concerningchanges in eye position or gaze orientation, and/or changes in the headposition of the user. In some embodiments, where these inputs areconstantly changing within determined threshold (e.g., a determinedfrequency of change), the biofeedback system may be configured todetermine that the user is unable to view the object or imageconformably. Accordingly, the ophthalmic system may be able to changethe optical prescription of the user in real-time without requiring userinput indicating the comfort level of viewing an image by, for example,alerting the user of the need for a new optical prescription or initiatea test to update the prescription.

In some embodiments, the ophthalmic system may be configured to receivean optical prescription from a third party. For example, a doctor may beable to send a user optical prescription wirelessly (e.g., over theinternet, Blue-tooth connection, etc.), which is received by a receiverand stored in the digital memory of the local processing module (70).

At 1004, the system may look up a mapping table to determine anappropriate image modification program (e.g., a program with anappropriate set of parameters) to modify one or more images to bepresented to the user. In some embodiments, the mapping table maycomprise an association of different optical prescriptions to differentimage modification programs. For example, for a given opticalprescription of the user, the mapping table may list an imagemodification program configured to compensate for the vision defects asdefined by the optical prescription.

In one embodiment, the image modification program defines modificationsto the incident wavefront to generate a compensating wavefront. Inanother embodiment, the image modification program defines modificationto the 2D image generated by the ophthalmic system and presented to theeye of the user. In one or more embodiments, the ophthalmic system maybe pre-coded with such programs, or these programs may be downloaded inorder to perform image modulation based on the prescription. See, forexample, the description below in connection with phoropter technology.In some embodiments, the remote processing module (72) may be executedto retrieve or look up the mapping stored in the remote data repository(74).

In some embodiments, each image modification program may comprise a setof parameters to be applied to the VFE or adaptable optics of displaydevice (62) based on the desired wavefront correction. Such parametersmay be a set of signals (e.g., electrical signals) that define themodifications to be applied to the shape and/or characteristics of theadaptable optics, thereby altering the wavefront. For example, for theVFE or adaptable optics, which may comprise one or more VFEs oradaptable optics (e.g., as described above, for example, in connectionwith FIGS. 10B-10E), the parameters may define the modification to theshape of the VFE or adaptable optics such that the wavefront presentedto the user is similarly modified. In another embodiment, where the VFEor adaptable optics is included in a waveguide stack (e.g., as describedabove in connection with FIG. 10D), the parameters may define changes tobe applied to adaptable optics integrated into the waveguides, so as toalter the phase, focal length, and wavefront of incident light based onthe optical prescription. In yet another embodiment, where theophthalmic device comprises a light modulator such as a phase modulatorconfigured to variably project light beams of varying phase and possiblyfocus in a raster pattern, the parameters may define the phase and/orfocus of the raster pattern. By modulating the phase, the wavefrontprojected by the light beams may be controlled to correct for visiondefects.

In another embodiment, each image modification program may comprise aset of parameters to be applied to the image generated by the ophthalmicsystem based on the desired modification to the image. For example, asdescribed above, the ophthalmic system may modify the color,magnification, shape, intensity, and/or distortion to correct fordefects in the eye. In some applications, the image modification programmay include parameters to modify the wavefront (e.g., phase) and theimage in combination.

The parameters of the image modification program and corresponding setof signals may be based on the optical prescription. For example, in thecase of myopia, the image modification program may have a set ofparameters configured to encode a negative power spherical wavefrontcurvature into the optics of the ophthalmic system (e.g., the VFE oradaptable optics of display device (62)). In the case of hyperopia, theimage modification program may have a set of parameters configured toencode a positive power spherical wavefront curvature into the optics ofthe ophthalmic system. In the case of astigmatism, the imagemodification program may have a set of parameters configured to definedifferent focal depths for the optics of ophthalmic system based on theon the shape of the user's cornea. For example, the eye of a usersuffering from astigmatism may comprise different optical powers alongdifferent axes or meridians of the cornea of the eye. Thus, the imagemodification program may include a set of parameters that definedifferent focal lengths, depth planes, optical powers or other opticalcorrections based on the optical prescription and shape of the eye.

In some embodiments, encoding a corrected wavefront comprises modifyingthe wavefronts of ambient light passed to the user from the surroundingworld, e.g., in front of the user and ophthalmic system. Similarly,encoding a corrected wavefront may comprise modifying the wavefront theimage generated by the ophthalmic device and projected by the displaydevice to the user. For example, an electrical signal may be applied toelectrodes coupled to the adaptable optics that alters the shape oroptical characteristics of the adaptable optics. This in turn may alterany wavefront incident on the adaptable optics. In some embodiments, thewavefront of the ambient light and any projected images may be bothmodified by either a single VFE or adaptable optics or independently bydifferent VFE or adaptable optics.

At 1006, an appropriate program may be selected. In one or moreembodiments, the mapping table may employ one to one association, manyto one association, or many to many association. For example, themapping table may associate one or more optical prescriptions with acorresponding one or more image modification program (e.g., that provideparameters that define alterations to be applied to the adaptableoptics) to be applied to the VFE or adaptable optics to modify thewavefronts. For example, in a case where the user suffers from one ormore vision defects, one optical prescription may correspond to multipleimage modification programs, or vice versa. Accordingly, in someembodiments, the ophthalmic system may utilize the local processingmodule (70) in communication with the remote processing module (72) toselect the appropriate program based on the optical prescription fromthe remote data repository (74). In another embodiment, 1006, or anyaspect of process flow 1000, may be performed locally on the localprocessing module (70).

At 1008, the appropriate image modification program may be applied toone or more images to be projected to the user's eyes. In someembodiments, the digital memory or remote data repository (74) may beconfigured to store image content (e.g., AR and/or VR image content).The local processing module (70), either independently or incommunication with remote processing module (72), may be configured toretrieve this image content and execute instructions based on theparameters of the appropriate program to modify the image projected tothe user. In some embodiments, the local processing module (70) mayexecute instructions based on the parameters and corresponding set ofsignals to modify the ambient light. In another embodiment, the remoteprocessing module (72) may execute instructions based on the parametersof the appropriate program to modify ambient light passed to the user.

The appropriate image modification program may be applied so as tomodify the wavefront of the image. In some embodiments, the wavefrontcompensation is performed by adjusting the shape of an adaptable optic.In some embodiments, the compensation may be implemented by alteringcharacteristics of adaptable optics integrated with a waveguide stack,thereby altering the focus depth, phase, and/or wavefront of incidentlight. In other embodiments, the appropriate image modification programmay be applied so as to modify one or more 2D images presented by theophthalmic display. For example, where each 2D image is a representationof the image at different focal depths, a 3D perception of the combinedimage can be provided to the user. In various embodiments, the localprocessing module (70) may be executed to encode the VFE or adaptableoptics of the display device (62) to modify the wavefront based on theoptical prescription in accordance with process flow 1000.

At 1010, the modified images are projected to the user such that theuser views the images comfortably. For example, the ophthalmic systemmay project light (38) to the user to form an image in the eye of theuser. The image may be a modified image based on the wavefrontcorrection applied by the VFE or adaptable optics of the display device(62) to an unmodified image. In another embodiment, alternatively or incombination, each 2D image (e.g., of different focal depths providingthe perception of a 3D image) generated by the ophthalmic system may bemodified based on software executed in the local processing module (70)and then displayed through display device (62). In some embodiments,where the ophthalmic device is an augmented reality head-mounted displaysystem, wavefront correction may be applied to an image to be presentedto the wearer while imaging objects located in front of the head mounteddisplay and the user. For example, AR image content presented by theophthalmic system may be modified and projected in combination withambient light. In some embodiments, the ambient light passing from theoutside world through the lens 106 may also be modified by theappropriate program to provide optical correction for a wearer viewingthe outside world through the lens 106. In another embodiment, in thecase of a VR head mounted display system that is opaque to the world infront of the user, the modified image may be a modification of a VRimage provided by the ophthalmic system and the display therein forvisual representation, for example, a VR image content.

Accordingly, the process flow 1000 may be implemented as a dynamicvision correction system. For example, the adaptable optics can bedriven by electrical signals that change the shape and/orcharacteristics of the adaptable optics, thus changing the optical powerof the adaptable optics. The altered characteristics of the adaptableoptics may then change the shape of a wavefront incident on theadaptable optics to produce a corrected wavefront. This wavefrontcorrection by the ophthalmic system may be changed in real-time as theoptical prescription of the user changes over time. For example, thevision correction may be adjusted at intervals in time (e.g., daily orat least two times a year, three times a year, or for four times a year,possibly monthly, etc.). The interval may be predetermined and based onan expected rate or occurrence of vision defects, deterioration, orchanges. For example, the vision of a user may change as the user ages.

In some embodiments, at 1010 the ophthalmic system may implement dynamicvision correction by initiating an eye-prescription configuratorprogram. At 1010, the ophthalmic system can be configured to return toblock 1002 and manually and interactively determine the user'sprescription at each interval, in some embodiments, without useractivation. Thus, the ophthalmic system may dynamically identify a firstoptical prescription at a first time and adjust the vision correctionbased on that prescription, and identify a second optical prescriptionat a second time and adjust the vision correction based on that secondprescription. In another embodiment, at any point during the use of theophthalmic system, the biofeedback system may monitor movements andchanges in the eye of the user (e.g., via camera 24), as describedabove. If the eye is constantly moving or the properties of the eyes areconstantly changing, the biofeedback system may determine that the useris struggling to focus or accommodate. Thus, the ophthalmic system maythen initiate an eye-prescription configuration program to determine anew optical prescription and/or adjust the image modification program.

The techniques shown in FIG. 10A-10E are example techniques of modifyingthe optics of the ophthalmic system or software algorithms to correctfor certain eye defects. It should be appreciated that any of thehealthcare defects described in further detail below may use either theoptical techniques or programming techniques, or a combination of bothto correct for one or more irregularities.

Presbyopia

In one or more embodiments, the ophthalmic system may be used tocompensate for presbyopia. Presbyopia is a reduction in an amplitude ofaccommodation of the crystalline lens of the eye, and is typicallyassociated with aging. For close objects, the crystalline lens of theeye changes shape and accommodates to focus the light received by theeye onto the retina to form an image thereon. With age, the ability ofthe crystalline lens of the eye to change shape and accommodate for neardistance viewing is diminished. Often, presbyopia is treated by using amulti-focal corrective lens system that comprises a divided lens (e.g.,bifocals, trifocals, etc.), or lenses with a continuous focal lengthgradient (e.g., progressive lenses) or variable focus mechanicallydeformable or liquid crystal lenses.

In one or more embodiments, the ophthalmic system may be configured toassist with presbyopia. In various embodiments, the ophthalmic devicecan function as a solid state variable focus lens with an adjustablefocus (e.g., adaptable optics or variable focus element (VFE)). Asdescribed above, for example, in correcting for myopia, hyperopia, orastigmatism, the ophthalmic system may be equipped with one or moreadaptable optics or VFEs. The adaptable optic may be dynamicallyaltered, for example by applying electrical signals thereto to changethe shape of a wavefront that is incident thereon. By altering theadaptable optic's shape or other characteristics, the wavefront ischanged, for example to focus of the wavefront on the retina for neardistance viewing as described herein in order to provide presbyopiacorrection.

As described above and shown in FIG. 5, the ophthalmic device mayinclude an augmented (or virtual) reality display device (62) thatincludes a display lens (106) and a light source configured to projectlight (38) that is directed into the eyes of a user to form images inthe eye of the user for the user's viewing. In various embodiments, thisdisplay device comprises a waveguide stack that received light from afiber scanning display disposed at the edge of the waveguide and couplesthe light out of the waveguide from the backside thereof to the wearer'seyes. In the case where the display device is an augmented realitydisplay device, the ophthalmic device may also direct ambient light fromthe surrounding world, e.g., light from in front of the user, to theeyes of the user through display lens (106). This light may, forexample, be transmitted through the waveguide stack to the wearer's eye.As discussed above, the display device (62) may also comprise one ormore adaptable optics or variable focus elements (VFEs). As describedabove, the adaptable optics may be an optical element that can bedynamically altered so as to alter the wavefront incident thereon. Forexample, the adaptable optic may be a reflective optical element such asa deformable mirror or a transmissive optical element such as a dynamiclens, such as described above in FIGS. 10B-10E.

In some embodiments, the user may be able to manually adjust the focusof the variable focus lenses by providing input to the system. Forexample, in one or more embodiments, the ophthalmic device may have afeedback mechanism (e.g., user interface controls) to increase ordecrease a power of the optics, or the focus of the images beingpresented to the user. The user input may cause the one or moreadaptable optics to change shape thereby altering the focus of thewavefront to cause the associated light and image to focus on theretina.

In one or more embodiments, the ophthalmic system may be configured toautomatically (e.g., based on a biofeedback system described below) orinteractively determine an optical prescription of a user (e.g., byemploying phoropter technology as described below) and incorporate theoptical prescription in the optical sub-parts of the ophthalmic system.In some embodiments, the wavefront of an image projected into the user'seye may be modified based on the determined prescription. For example,the wavefront of ambient light in front of the user may be incident onadaptable optics of the ophthalmic system and, may be corrected based onthe prescription. In another embodiment, alternatively or incombination, the wavefront of an image generated by a display of theophthalmic system and presented to the user by the display of the systemmay be corrected based on the prescription. For example, the phaseand/or focus of the wavefront of the projected image may be modifiedsuch that the projected image appears to be in focus and corrected basedon the optical prescription.

In some embodiments, an ophthalmic system configured to correct forpresbyopia may be similar to the ophthalmic system described above forcorrecting for myopia, hyperopia, and/or astigmatism. In someembodiments, the ophthalmic system may be configured to correct forpresbyopia along with myopia, hyperopia, and/or astigmatism.

In some embodiments, the ophthalmic system may be an augmented realitysystem that combines AR and VR techniques to correct for presbyopia. Asdescribed above, the ophthalmic system may be an augmented reality headmounted display system configured to provide wavefront correction toambient light from the world in front of the user, as well as providingwavefront correction to AR image content generated by the ophthalmicsystem. Alternatively, the ophthalmic system may be a VR head mounteddisplay system configured to produce VR image content generated by theophthalmic system having a corrected wavefront and provided to the userwhile the user's eyes are covered from ambient light in front of theuser by the VR head mounted display system. As described previously, aVR head mounted display system may include outward facing camerasconfigured to capture ambient light from the world in front of the user,and generate and project corrected wavefronts of these images into theeye of the wearer.

For example, the ophthalmic system may be a patient-worn ophthalmicdevice as illustrated in FIGS. 3A-3D and 5 that may be implemented tocompensate for presbyopia. The ophthalmic device includes a displaydevice (62) that includes a light source configured to project light(38) that is directed into the eyes of a user in a display lens (106)and displayed by a rendering engine (34) of the display device (62). Theophthalmic device may also direct ambient light from the surroundingworld to the eyes of the user through display lens (106), e.g., lightfrom in front of the user. The display device (62) also comprises one ormore VFEs or adaptable optics. As described above, the VFE or adaptableoptics may comprise an optical element that can be dynamically alteredso as to alter the wavefront incident thereon. For example, theadaptable optic may be a reflective optical element such as a deformablemirror or a transmissive optical element such as a dynamic lens, such asdescribed above in FIGS. 10B-10D. As described above in FIG. 10E, theVFEs or adaptable optics may be included in the display lens (106) orlocated between the display lens (106) and the light source. The VFEs oradaptable optics may also be integrated into a waveguide stack or lightsource (18). Furthermore, the VFEs or adaptable optics may be positionedbetween the waveguide stack and the world in front of the ophthalmicdevice and user. The VFEs or adaptable optics may also be positionedbetween the waveguide stack and the eye of the user. In anotherembodiment, the adaptable optic may be positioned between waveguides ofthe waveguide stack.

In some embodiments, the VFEs or adaptable optics may be altered as tomodify the phase and/or focus of the wavefront incident thereon.

In some embodiments, alternatively or in combination, adaptable opticscomprises a spatial light modular configure to modify phase on a pixelby pixel basis. Optical correction can therefore be imparted on thewavefronts. In various embodiment therefore, the ophthalmic device maybe configured to drive the light modulator to compensate for presbyopia.

In various embodiments, the ophthalmic device includes one or more eyetracking camera or other cameras or imaging systems to track the eye.Such cameras and/or imaging systems can monitor the orientation of theeyes and the corresponding direction of the line of sight of therespective eyes. These cameras and imaging systems may also be part of abiofeedback system configured to monitor the user's comfort in viewingimages and provide feedback for monitoring or modifying an opticalprescription.

In one or more embodiments, the ophthalmic system may comprise one ormore sensors configured to detect an orientation of a user's gaze. Thesesensors may also be part of the biofeedback system. For example, if thewearer's eyes are tilted forward and downward, the wearer may be lookingat a closer object such as a book or may be looking at projected imagecontent corresponding to images placed in a location (lower part offield of view) typically associate with nearby objects. The gaze mayalso be determined based the vergence of the eyes, (see e.g., thedescription above in connection with FIG. 6), for example, how the linesof sight of the pair of eyes converge on a location and how far thatlocation is with respect to the wearer. Accordingly, by monitoring thevergence, the distance at which the viewer is intending to view anobject may be determined.

In another embodiment, the one or more sensors may be configured todetect a head position. In one embodiment, the distance at which theviewer is intending to view an object may be estimated or detected basedon a user's head position (e.g., head pose, or orientation), e.g.,forward tilt. For example, if the wearer's head is tilted forward anddownward the wearer may be looking at a closer object such as a book ormay be looking at projected image content corresponding to images placedin a location (lower part of field of view) typically associate withnearby objects.

In some embodiments, the ophthalmic device of FIGS. 3A-3D may comprisegyroscopic sensors configured to determine a head positions, (e.g., headpose or head orientation), or head movement of the user (e.g., straight,tilted down, looking up, etc.). In some embodiments, the display device(62) may comprise a sensor assembly (39) having accelerometer,gyroscope, and/or other types of orientation and/or movement sensorsseveral of which are discussed elsewhere herein. The sensor assembly(39) may be configured to detect movement imparted onto and orientationof the display device (62) due to movement of the user's head. Thedisplay device (62) may also include processor (32) (e.g., a head poseprocessor) operably coupled to the sensor assembly (39) and configuredto execute digital and/or analog processing to derive head positions,head pose, and/or orientation from movement detected by the sensorassembly (39). In one embodiment, sensor assembly (39) may generatemovement data stored in a digital memory. In some embodiments, themovement data may be used to reduce noise while diagnosing visualdefects (e.g., detecting a head movement during a test may be indicativeof a faulty test and result). The processor (32) may retrieve thismovement data and execute processing logic to determine head positions(e.g., head pose or orientation).

In one or more embodiments, gaze orientation may also be based ontracking eye movement through an eye tracking system. In one embodiment,the prescription may be correlated with a set of user eye convergencepoints that are indicative of a focus depth of the eye. For example,while the user's head position may be unchanged, the user's eyes may betracked to a convergence point that is below the horizon. Such movementmay be indicative of the eye focusing on an object located at anear-field focal depth. Also, as discussed above, the vergence of theeyes can assist in determining the distance at which the viewer isdirection attention (e.g., focusing). This distance may be ascertainedfrom the convergence of the lines of sights of the eyes. Accordingly, invarious embodiments, the user's eyes may be tracked to a convergencepoint at a particular distance from the wearer.

Likewise, in various embodiments, the ophthalmic system may beconfigured to determine a focal depth at which the eyes are focused oraccommodated. In some embodiments, eye-tracking system may be used totriangulate the user's convergence point and adjust the focus of theimages to be presented to the user accordingly. For example, theeye-tracking system may determine a direction that each eye is viewingalong (e.g., a line extending from each eye) and determine a convergenceangle where the directions intersect. The convergence point may bedetermined from the determined angle of convergence. In someembodiments, the eye-tracking system may be included as part of thebiofeedback system. As described above, in various embodiments, theophthalmic system may utilize cameras (24) paired with light sources(26) (e.g., an infrared light source and infrared camera) to track theposition of each eye, which can be operatively coupled to the localprocessing module (70). The local processing module (70) may includesoftware that, when executed, may be configured to determine theconvergence point of the eyes, as described above in reference to FIG. 6and/or the direction of the eyes. From this determination, theophthalmic system may also execute logic device to determine a focuslocation or depth based on the orientation or direction of the user'sgaze.

In another embodiment, gaze orientation may be determined through glintdetection. The eye tracking system may be configured to discern one ormore glints or reflections from the eye and determine a position of theone or more glints on the eye relative to the features of the eye (e.g.,pupil, cornea, etc.). As the eye is moved, the relative position of theglint on the eye may change. For example, if a glint is located at thetop of an eye and the space between the glint and the pupil increases,this may be indicative that the gaze orientation has tilted downward,the eyes may be accommodating at a near-field focal depth.

In some embodiments, the ophthalmic device may include one or moretransmitters and receivers to allow transmission and reception of databetween the ophthalmic device and the remote processing module (72)and/or remote data repository (74). In some embodiments, any of theprocessing steps executed by the local processing module (70) anddigital memory therein may be performed remote from the user by remoteprocessing module (72) operatively coupled to remote data repository(74).

In one embodiment, the ophthalmic system may include a rendering engine(34) operatively coupled (105, 94, 100/102, 104) to processor (32), thehead pose processor (36), cameras (24), light source (18), localprocessing module (70), and remote processing module (72). The renderingengine (34) may be configured to render an image to be projected to theuser via projected light (38) having a wavefront that is modified, bent,or focused at selected focal depths based on the optical prescriptionand/or gaze orientation.

Referring to FIG. 11, an example process flow of such a system isbriefly described. The process flow 1100 is directed to modifying animage presented to the user based on a prescription of the user. In someembodiments, process flow 1100 may be performed by patient-wornophthalmic devices, such as those described in connection with FIGS.3A-3D. In various embodiments, the VFEs or adaptable optics described inFIGS. 10B-10E may be used to provide correction for presbyopia based onthe user's optical prescription. The process flow 1100 can beimplemented by the local processing module (70), possibly for example,by the remote processing module (72) executed by logic devices in thelocal processing module (70) operably connected to the remote daterepository (74). In other embodiments, process flow 1100 may beimplemented by processor (32), head pose processor (36), and/or sensorassembly (39). Other configurations are possible. Any combination oflocal and/or remote processing may be employed.

At 1102, a presbyopia prescription is determined for the user. As wasthe case in the previous discussion in reference block 1002 of FIG. 10A,the prescription may be determined by receiving information from theuser, or may be determined by the ophthalmic system itself by adjustingthe wavefront presented to the user and the user selecting a desiredprescription. For example, the ophthalmic system may be configured totest for an optical prescription for different focal planes ofaccommodation. In some embodiments, the ophthalmic system may bepre-programmed with discrete granular steps in altering wavefronts of animage presented to the user through the display device (62) for aplurality of focal depths. For example, the ophthalmic system may employphoropter technology, as described herein. In some embodiments, thewavefront incident on a given waveguide of the waveguide stack (178)(e.g., associated with a selected focal depth) may be altered to correctfor refractive errors in order to define the optical prescription. Theprescription may be entered by the user through a user interface and maybe stored in the remote data repository (74). The prescription may beretrieved by one or more processors of the ophthalmic system, forexample, remote processing module (72).

In another embodiment, the ophthalmic system may automatically andpossibly incrementally change the user's prescription via thebiofeedback system. The biofeedback system may be configured todetermine a comfort level of the user in viewing an object or image. Forexample, as described above in connection with FIG. 10A, if a user'seyes are unstable, shifting, oscillating, changing accommodation (e.g.,in an unsteady or random manner), etc., these may be indicators that theuser is unable to comfortably view the object. Accordingly, theaccommodation, vergence, pupil size, etc., may be monitored and/or anautorefractor may be used to see if an image is focused on the fovea ofthe retina.

In some embodiments, the ophthalmic system may be configured to receivean optical prescription for presbyopia (e.g., the added optical power)from a third party. For example, a doctor may be able to send a useroptical prescription wirelessly (e.g., over the internet, Blue-toothconnection, etc.), which is received by a receiver or transceiver andstored in the digital memory of the local processing module (70).

At 1104, the system may store information on compensating wavefrontsand/or lens types. The wavefronts and/or lens types may be based on theoptical prescription of the user for various focal depths ofaccommodation (e.g., which may also include different focal depths fordifferent parts of the eye). In some embodiments, the information may beinput parameters for varying the focal depth, altering the shape, oraltering other optical characteristics the VFEs or adaptable optics, toprovide refractive correction to the eye. In some embodiments, thedifferent lens types may refer to the modified or altered VFEs oradaptable optics as defined by the input parameters.

In some embodiments, each corrective function comprises a set of inputparameters that define adjustments to shape and/or characteristics ofthe adaptable optic to achieve the desired wavefront correction. Theinput parameters may be similar to the parameters of the imagemodification programs of block 1004 of FIG. 10A, but are based on theoptical prescription for correcting a user's presbyopia when the weareris focusing at a near-field focal depth. For example, in the case wherethe adaptable optic is VFE (1020) of FIG. 10B, the input parameters maydefine a plurality of voltages to be applied to electrodes (1022) so asto modify the VFE (1020) to compensate for the presbyopia based on theprescription when the wearer is focusing at a near-field focal depth. Inthe case of a stacked waveguide assembly (178), the input parameters maydefine changes to be applied to VFEs or adaptable optics integrated intothe waveguides, so as to alter the phase, focal length, and wavefront ofincident light based on the optical prescription when viewing closeobjects and/or images presented at near depth planes, as described abovewith reference to FIG. 10D. In some embodiments, each waveguide may beassociated with a given focal depth, thus the waveguide may beselectively addressed to correct the wavefront for a given focal depthof accommodation.

In one embodiment, local processing module (70) may execute instructionsto retrieve the prescription from a digital memory, determine inputparameters defining the alternations for the VFEs or adaptable optics,and store the input parameters in the digital memory. In someembodiments, remote processing module (72) and remote data repository(74) may also be used.

Without subscribing to any scientific theory, the eye of a user mayexperience different refractive errors and/or need for opticalcorrection based on the focal depth that the eyes are accommodating.Accordingly, in one or more embodiments the system may create a map ofthe distances of the eyes for a plurality of different depth planes(e.g., 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, or moredepth planes) and corresponding corrective functions to compensate forrefractive errors associated with accommodating at varying focal depths.For example, the ophthalmic system may determine at least one of theuser's eyes has a positive spherical wavefront while accommodating atone focal depth and areas of the user's eye need a negative sphericalwavefront for another focal depth (or a different amount of prescriptioncorrection). Accordingly, different convergence points, and thereoffocal depths of accommodation, are also correlated with differentprescription correction.

In one or more embodiments, this information may further be correlatedwith a set of head positions (e.g. head poses, orientations), and/orgaze directions. For example, if the user's head is tilted downward, theeyes may be accommodating at a certain (e.g., closer) focal depth. Or ifthe user's head is tilted to the right, the eyes may be accommodating atanother focal depth. Accordingly, in various embodiments, programsspecific for presbyopia may be pre-programed into the ophthalmic system(or downloaded) such that the right head position (e.g., head pose,orientation) and/or gaze orientation and focal depth at which the eyeexperiences optical shortcoming can be matched correctly. Different gazedirections and head orientations are thereof correlated with differentprescription correction for different focal depths associated withaccommodation. The ophthalmic system thus is configured to provide adifferent optical correction depending on a measured gaze directionand/or head position, head pose, or orientation.

At 1106, the system may detect, through gyroscopes, accelerometers,IMUs, other sensors, or combinations thereof, an orientation of theuser's gaze and/or head position, head pose, or orientation. The gazeorientation (e.g., including the convergence point of the eyes) and/orhead position, head pose, or orientation may be indicative of whetherthe wearer is viewing near or far and thus whether the wearer need toaccommodate, as described above. Accordingly, different correctivefunctions may be used for different focal depths of accommodation.

In some embodiments, as described above, the head position, head pose,or orientation of the user may be detected by a gyroscope,accelerometer, IMUs, other sensors, or a combination thereof. Forexample, a described above, the ophthalmic device comprises sensorassembly (39), processor (32), and head pose processor (36) which may beconfigured to detect movement, tilt, and orientation of the user's head.In some embodiments, sensors may be operably coupled to local processingmodule (70) and which may execute logic devices to retrieve the detectedhead movement and/or determined head position, head pose, ororientation. A downward movement of the user's head may be indicative offocusing on an object in the near-field.

In some embodiment, the gaze orientation may be based on tracking theeye movement, as described above. For example, downward movement of oneor more eyes of the user may be indicative of focusing on an object inthe near-field (e.g., shifting view from the horizon to a book heldbelow the horizon). Thus, if the eye tracking system determines that theuser's eyes have shifted downward, an appropriate corrective functionmay be determined based on the presbyopia prescription. In anotherembodiment, the eye tracking system may be configured to determine theangle of convergence is increasing (e.g., the convergence point isbecoming closer to the user). Such determination may be indicative offocusing on an object in the near-field. From this determination, theophthalmic system may determine that a convergence point is below thehorizon, which may also be indicative of focusing at a near-field focaldepth. Thus, the ophthalmic system may be able to determine focal depthof accommodation.

In some embodiments, the system may utilize cameras (24) to track theposition of each eye, which can be operatively coupled to the localprocessing module (70). In another embodiment, the system may utilizecameras (24) to perform glint detection and monitoring, for example, thecamera (24) tracks the position of a glint with respect to features ofthe eye (e.g., edge of the eye, intersection of the eye with an eye lid,pupil, etc.). The local processing module (70) may include softwarethat, when executed, may be configured to track eye movement, glintmovement, and/or determine the convergence point of the eyes. In someembodiments, the gaze orientation may be stored in the remote datarepository (74).

For example, in some embodiments, the remote processing module (72) maybe configured to correlate gaze orientation, angle of convergence,and/or head position information with the optical prescription, bothbeing stored in the remote data repository (74).

At 1108, based on the detected gaze orientation and/or head position,the system consults the mapping table (e.g., the information stored at1104) to determine an appropriate corrective function to apply to theadaptable optic to produce a compensating wavefront and/or lens type.For example, based on the gaze orientation or direction and/or headposition (e.g., head poses, orientation), the system may determine afocal depth that the eye is accommodating. In various embodiments, theoptical prescriptions may be correlated with one or more focal depthsassociated with accommodation. For example, different convergencepoints, and therefore focal depths associated with different amounts ofaccommodation, may be correlated with a different optical prescriptionsand corrective functions.

In various embodiments, at 1108, the system may retrieve the detectedfocal depth of accommodation and may consult the mapping stored at 1104.Based on the mapping, the system may determine the appropriatecorrective function for that identified focal depth. The appropriatecorrective function includes the parameters for applying to the VFEs oradaptable optics to produce the appropriate compensating wavefront. Forexample, the compensating may be defined by parameters of the selectedcorrective function.

In some embodiments, the local processing module (70) may retrieve thedetected gaze orientation stored in a digital memory at 1106. Or, thelocal processing module (70) may receive the detected gaze orientationdirectly from the eye tracking system, sensor assembly (39), and/or headpose processor (36). The local processing memory (70) may execute logicdevices to access the mapping table stored at 1106 and, based on thegaze orientation, angle of convergence, and/or head position (e.g., headpose, orientation), select an appropriate corresponding correctivefunction to be applied to the adaptable optic to compensate for thepresbyopia.

At 1110, the appropriate compensating wavefront and/or lens type, e.g.,an amount of optical power (e.g., positive spherical power) is appliedto one or more images. In some embodiments, the appropriate correctivefunction is applied to the VFEs or adaptable optics so as to alter theshape and/or characteristics of the VFEs or adaptable optics. This, inturn, may modify a wavefront incident thereon to correct for refractiveerrors. e.g., presbyopia.

In some embodiments, where the adaptable optic is a variable focuselement (VFE), the shape of a VFE is adjusted based on voltages appliedto electrodes to alter the shape and/or optical characteristics of theVFE. In some embodiments, the local and/or remote processing module (70,72) may be configured to encode the appropriate compensating wavefrontinto the VFEs or adaptable optics of the display device (62) based on anappropriate corrective function, as selected based on the opticalprescription and gaze orientation. For example, the local and/or remoteprocessing module (70, 72) may execute logic devices configured to alterthe VFEs or adaptable optics to change to wavefront incident thereon andpass a corrected wavefront to the eye of the user based on the opticalprescription. For example, the local processing module (70) may beoperatively coupled to electrodes connected to the adaptable optic andcause the electrodes to apply an electrical signal thereto to alteradaptable optic thereby changing the shape of a wavefront incidentthereon.

At 1112, the modified image is presented to the user. For example, theophthalmic system may include rendering engine (34) operatively coupled(105, 94, 100/102, 104) to the processor (32) local processing module(70), and/or remote processing module (72). The rendering engine (34)may be configured to render an image to be projected to the user viaprojected light (38) having a wavefront that is modified, bent, orfocused at selected focal depths based on the selected correctivefunctions as applied to the compensating lens at block 1110.

In some embodiments, the image may be a modified image based on thewavefront correction applied by the VFEs or adaptable optics of thedisplay device (62) to an unmodified image. In some embodiments, wherethe ophthalmic device is an augmented reality head-mounted displaysystem, wavefront correction may be applied to an image to be projectedto the wearer, while also passing ambient light located in front of thehead mounted display to the eye of the user. For example, AR imagecontent presented by the ophthalmic system may be modified and projectedin combination with ambient light. In some embodiments, the ambientlight may also be modified and optically corrected by the appropriateprogram. In another embodiment, in the case of a VR head mounted displaysystem that is opaque to the world in front of the user, the modifiedimage may be a modification of a VR image provided by the ophthalmicsystem for visual representation, for example, VR image content.

Accordingly, the process flow 1100 may be implemented to dynamicallycorrect a user presbyopia. For example, the VFEs or adaptable optics canbe driven by electrical signals that change the shape and/orcharacteristics of the VFEs or adaptable optics, thus correcting for auser's presbyopia as it changes over time. The components can thus bedynamically reconfigured, for example, reconfigured electrically inreal-time as the optical prescription of the user changes and hencerepeatedly updated during use of the ophthalmic system. For example, thepresbyopia prescription correction may be adjusted at a variety ofintervals in time (e.g., every day, once a month, three times, a yearetc.) periodic or non-periodic. The ophthalmic system may therefore beconfigured to dynamically correct for changes in a user's presbyopiaprescription over time, for example, 2, 3, 4, 6, or more times a yearwithout requiring replacement or substitution of parts into the system.The interval may be predetermined and based on an expected rate oroccurrence of vision defects, deterioration, or changes. For example,the presbyopia of a user may change as the user ages.

In some embodiments, at 1010 the ophthalmic system may implement aneye-prescription configuration program. At 1010, the ophthalmic systemcan be configured to return to block 1002 to update or adjust theprescription based on inputs from the biofeedback system, as describedabove, to manually and interactively determine the user's prescriptionat each interval, without user activation. Such procedures can bescheduled by a protocol (e.g., configured to check once a month, acouple times a year, etc.) or when determined that vision, for example,near vision, is deteriorating. In another embodiment, as describedabove, the biofeedback system may monitor movements and changes in theeye of the user (e.g., via camera 24 and light source 26) to determinethat the user is struggling to accommodate. For example, the ophthalmicsystem may monitor vergence, pupil dilation, and/or movement and/orshape of the natural lens of the eye. The ophthalmic system may also usean autorefractor, or other technology as described herein, to monitor animage formed on the fovea of the retina. The ophthalmic system may theninitiate an eye-prescription configuration program to determine a newoptical prescription and/or adjust the corrective function (e.g., updatethe mapping table of focal depths and lens types).

In one or more embodiments, the ophthalmic system may allow the user tomanually adjust the focus of one or more images presented to the user.For example, the system may be pre-programed with discrete steps inadjusting focus. The user may then specify the desired focus to theophthalmic system through a user interface. In some embodiments, theuser may have the option of incrementally increasing or decreasing aprescription (e.g., changing the focus) until the user arrives at acomfortable viewing focus. Or, the ophthalmic system may possiblyincrementally increase or decrease a prescription automatically byutilizing the biofeedback system and other diagnostic technologies (seefor example, the description of phoropter and autorefractor technologyherein). In some embodiments, such user input prescriptions may beassociated with a particular gaze or head orientation and provided whenthe wear has such gaze or head orientation. In some embodiments, suchuser input prescription is applied independent of the gaze or headorientation and is not changed with change in gaze, line of sight,and/or head orientation.

Strabismus/Amblyopia

Another common visual ailment is strabismus, which is an inability ofboth eyes to align at a single convergence point in order to produce afused stereo image. This typically results from an eye with weakenedocular muscles being unable to coordinate its motions with that of itsnormal counterpart. Similarly, amblyopia is a visual ailment where thereis decreased vision in one or both eyes. This decreased vision may becaused by abnormal development of vision in infancy or during childhood.Amblyopia is sometimes referred to as a “lazy eye.”

In some embodiments, an ophthalmic system comprising a wearableaugmented reality head-mounted device, similar to the devices describedherein, may be used to treat or correct convergence deficiencies, suchas deficiencies resulting from strabismus or amblyopia. As an example,if the convergence is offset in an angular fashion, a compensating prismcorrection may be applied to bring the convergence point of both eyestogether. The compensating prism correction may be applied by theprocessor, adaptable optics elements, or a combination of both. Thisprocess generally follows the method described herein with reference toFIG. 10 a.

Where the convergence of both eyes is offset angularly, one or more ofthe following techniques may be used. In one or more embodiments, an eyetracking system may determine a gaze vector and/or a point of focus of ahealthy eye. This information may be extrapolated to determine atargeted convergence point for both eyes. In certain embodiments, an eyetracking system and a depth sensing system may be used in conjunction todetermine the convergence point of both eyes. In certainimplementations, muscles of one or more eyes may be “re-trained” througha treatment protocol to gradually align the focus and/or convergencepoint of both eyes. The treatment protocol can include the methodsdescribed herein, including methods that are designed to strengthenmuscles of a weaker eye and/or to stimulate neural responses to opticsignals from a weaker eye.

In some embodiments, a wearable augmented reality (or virtual reality)device can be used as an ophthalmic system to identify, treat, and/orcorrect convergence deficiencies, such as those resulting fromstrabismus and/or amblyopia. The augmented reality device can beconfigured to correct or compensate for vergence deficiencies byapplying a compensating prism correction, as described herein. Theaugmented reality device can be configured to re-train eyes of thewearer to gradually align the convergence point of both eyes. It shouldbe appreciated that such a system may be used to test and/or treat theeyes of the wearer, and this may or may not occur at a doctors orclinician's office. In one or more embodiments, the patient's individualophthalmic system may be used, possibly with doctor supervision, or thedoctor's office may have its own version of the ophthalmic system thatmay be used for testing and/or treatment.

In various embodiments, the wearable augmented reality device includesan augmented reality display platform configured to pass light from theworld or environment beyond the eyewear through the display platform(e.g., a lens and/or adaptive optics elements in the front thereof) tothe eye of the wearer. The display platform can be configured similarlyto the display lens 106, as described herein, for example, withreference to FIG. 5. Accordingly, the wearer can see images projectedwith the display platform superimposed with what the wearer can see inthe world.

In some embodiments, the wearable augmented reality device includes thedisplay platform described above and at least one light sourceconfigured to project light into the eye of the wearer. The at least onelight source can be configured to project light into the eye of thewearer to form an image in the eye. In some embodiments, the at leastone light source includes a fiber scanning display, such as describedherein. The fiber scanning display can be configured to display ortransmit light from one or more depth planes.

In some embodiments, the display platform includes a waveguide stack,such as described herein. The waveguide stack can be configured toproject light from different focal planes. In certain implementations,the waveguide stack includes one or more lenses in the stack, asdescribed herein. The waveguide stack can be configured to apply acompensating prism correction, for example, through configuration oflenses, mirrors, reflective elements, refractive elements, or thecombination of any of these components. In various implementations, thewaveguide stack can be configured to vary its mechanical configurationto provide a compensating prism correction.

In some embodiments, the display platform includes adaptable opticselements configured to project light to different or targeted portionsof the eye of the wearer. In certain implementations, the adaptableoptics elements include variable focus elements (VFEs), as describedherein. In some embodiments, the variable focus elements include amembrane mirror. The membrane mirror can include one or more electrodeson the mirror and a control system that is configured to control the oneor more electrodes to modify a shape of the membrane mirror. Theadaptable optics can be used to provide a compensating prism correctionfor correction and/or treatment of convergence deficiencies. In certainimplementations, the augmented reality device is configured to vary thefocus and/or position of the projected image by varying amicroelectromechanical system (MEMS). For example, the augmented realitydevice can include micro-optics implemented using MEMS that includereflective, refractive, and/or diffractive optics elements that can beused to vary the focus and/or position of the projected image. In someembodiments, the augmented reality device includes an array ofmicro-mirrors that are configured to respond to signals to alter theirorientation. This can be done, for example, to provide an image shift(e.g., a compensating prism correction) and/or to occlude an eye of thewearer. Other types of adaptive optics may be used to provide prism. Forexample, transmissive elastomeric material (such as used in an adaptiveoptics lens) that is affected by electric field may be driven byelectrode to change shape so as to introduce prism. Phase modulators,including transmissive or reflective phase modulators, may also be used.Such phase modulators may alter the phase on a pixel by pixel based.Possible phase modulators include liquid crystal phase modulators. Insome embodiments, the augmented reality device includes one or morespatial light modulators configured to control intensity, for example,attenuate or occlude, on a pixel by pixel basis. For example, liquidcrystals configured to selectively occlude an eye or eyes of the weareror a portion of the eye or eyes of the wearer or attenuation intensityto said eye or eyes. The liquid crystals may also be configured toselectively turn on or off the effects of a diffraction grating (e.g., aholographic diffraction grating). This can be done, for example, toselectively apply a prismatic effect. Such adaptive optics can be in theoptical path from the display to the eye to provide correction for theuser when viewing image content on the display. These adaptive opticscan also be included in the optical path from the world in front of theeyewear and the eye to provide correction for the user when viewing theworld in front of the eyewear.

The augmented reality device can be configured to selectively introducea prismatic effect or an angular shift in images provided to the wearer.This can be done in a number of ways and for different purposes. Forexample, a compensating prism correction can be applied as an opticalcorrection for the wearer, e.g., to compensate for convergencedeficiencies in one or both eyes of the wearer. This correction can beapplied to account for the deficiencies of the wearer so that the wearercan achieve or approximate binocular single vision even where the wearersuffers from strabismus and/or amblyopia.

The compensating prism correction can be achieved by shifting, e.g.,laterally (e.g., orthogonal to the normal line of sight or normal to theoptical axis), a location of an image provided to the wearer. In someembodiments, the shift in location can be provided in image processing.For example, the augmented reality device can be configured to adjustvia software relative location of the images presented in the display orthe relative locations of an image being projected in one or both eyesof the wearer compared to the relative locations of the image beingprojected to a wearer that does not suffer from convergence deficienciesor to the other eye. The augmented reality device can be configured todetect the focal point or the alignment of the eyes of the wearer and toadjust the positions of the respective left and right images to be at atargeted point within the field of view of each eye. For example, theaugmented reality device can include eye tracking to determine the gazeof each eye. When the gaze is determined, the augmented reality devicecan be configured to position respective left and right images centeredwithin the field of view of the respective left and right eyes. In someembodiments, to re-train a weaker eye, the augmented reality device cangradually move the image presented to the weaker eye towards a desiredor targeted convergence point. In this way, the weaker eye can bere-trained to verge at the same point as the strong eye. In someembodiments, the shift in location can be provided optically. Forexample, the augmented reality device can include adaptable opticselements configured to optically shift the location of an image to oneor both eyes of a wearer (e.g., laterally) or shift the image on thedisplay. Similarly, the augmented reality device can include adaptableoptics elements to add a prism to shift light arriving to the wearerfrom the world or environment outside of or beyond the eyewear. In someembodiments, the lateral shift in location can be provided optically incombination with image processing.

To determine the amount of prism correction to apply, the augmentedreality device can be configured to monitor where the image and lightwere being projected on the retina of the weak eye of the wearer. If theprism correction allows the light to shine on the retina, then it iscorrect. If not, more or less is needed. As described herein, W4LT, SLO,autorefractor, photo-refractor, etc. can be used to determine if thecompensating prism correction has reduced or corrected the misalignedvision of the wearer. In some embodiments, the augmented reality deviceis configured to determine (or receive input indicating) whether theuser has an exotropic or esotropic deviation. Once this deviation isknown by the device, prism corrections can be applied until the visiondefect is substantially corrected. This may be determined automaticallyor it can be determined based on user input. In some embodiments, todetermine a correct or suitable prism correction automatically, theaugmented reality device can include one or more inward-facing camerasto measure angular deviation (e.g., a shift in fixation) and use thedisplay to occlude one eye while changing the prism prescription in theother. In some embodiments, to determine a correct or suitable prismcorrection using user input, the augmented reality device can beconfigured to implement a test similar to a Maddox rod test. Forexample, the augmented reality device can provide a mechanical filter tofilter light for the test. As another example, the augmented realitydevice can provide image sources from two different depth planes. Basedon user input, the augmented reality device can adjust the prismcorrection until satisfactory conditions are met (e.g., a first image isaligned with a second image).

As another example, a compensating prism correction can be applied for atherapeutic purpose, e.g., to gradually re-train the eyes to arrive at atargeted convergence point. Disclosed herein are also methods forre-training eyes that emphasize the presentation of images of differingcharacteristics to respective eyes of the wearer.

In some embodiments, the wearable augmented reality device includes aneye tracking system. The eye tracking system can be configured todetermine gaze of the wearer's eyes. The eye tracking system can includeone or more sensors configured to sense properties of the eyes of thewearer. In some embodiments, the one or more sensors include cameras, asdescribed herein. In various embodiments, the one or more sensorsincluding cameras can be configured to image the glint and/or Purkinjefringes to determine a gaze. The eye tracking system can include ananalysis module configured to determine a direction of gaze of thewearer's eyes based at least in part on the information acquired withthe one or more sensors.

In some embodiments, the wearable augmented reality device includes oneor more outward facing cameras. In certain implementations, the one ormore outward facing cameras can be similar to the cameras 16 describedherein with reference to FIG. 5.

The wearable augmented reality device can include one or more userinterface features configured to allow a wearer or other person toprovide input to the device. The user interface features can beintegrated with the device. In some implementations, the user interfacefeatures are provided by a device or component that is not physicallyintegrated with the device. For example, the user interface features canbe provided by a device or system that is in communication with thedevice. This can be a smartphone, computer, tablet, or othercomputational device that is in wired or wireless communication with thedevice. In some embodiments, the user interface features can be providedby a combination of different devices and systems linked to the device,e.g., through wired or wireless communication networks or throughcomponents that are physically linked to the device or integrated withthe device. The user interface features can be presented on a devicewith a touch screen wherein interaction with the touch screen providesinput to the wearable augmented reality device. Voice recognition and/orvirtual touch screen technology can also be employed. The user interfacefeatures can include capacitive features sensitive to touch, keyboards,buttons, microphones, photodetectors, or a variety ofsoftware-implemented features provided by a graphical user interface. Insome embodiments, the user interface features include gesture detectioncomponents to allow a wearer to provide user input through gestures. Insome embodiments, the user interface features include gaze detectioncomponents to allow a wearer to provide user input through gaze of theeyes (e.g., this can include selecting a button or other element whenthe wearer fixates on the button for a time or when the wearer blinkswhen fixated on the button). Such systems can be used for other devicesand systems described herein. The user interface features can bepresented on a device with a touch screen wherein interaction with thetouch screen provides input to the wearable augmented reality device.

In some implementations, the wearer, clinician, doctor, or other usercan use the interface features to control aspects of the vision testingand/or therapy. This can be done, for example, to change the amount ofprism correction applied, the amount of lateral shift of the images, tomodify characteristics of enhanced images, or to otherwise configuretesting or treatment of convergence deficiencies.

FIG. 12 illustrates an example method 1200 for treating convergencedeficiencies, such as those caused by strabismus and/or amblyopia. Forease of description, the method 1200 will be described as beingperformed by an ophthalmic system, such as any of the augmented realitydevices described herein. However, it is to be understood that anycomponent or subpart of the various augmented reality devices disclosedherein or other similar devices can be used to perform any step,combination of steps, or portions of a step in the method 1200. Themethod 1200 includes a process of “re-training” a lazy eye or misalignedeyes by occluding or de-emphasizing the stronger eye. It should beappreciated that many treatment protocols may be devised based on auser's particular prescription, and the exact parameters and/ortechniques may vary.

At block 1202, the ophthalmic system determines a difference in thefocus and/or convergence points of both eyes. As discussed herein, thisdifference may be determined based on user input or based on aprescription test performed by the ophthalmic system. Eye trackingand/or gaze detection can also be used. The ophthalmic system can beconfigured, for example, to perform any of the methods described hereinfor determining focus points and/or convergence points.

At block 1204, the ophthalmic system selects a treatment protocol tohelp treat the wearer's visual defect. In some embodiments, thetreatment protocol may be devised by a doctor or clinician or thetreatment protocol may be devised at an external location and downloadedonto the ophthalmic system. The treatment protocol may comprise variousparameters of the treatment protocol. For example, the treatmentprotocol may involve a frequency at which the treatment is administered.The treatment protocol may include information on the type of images tobe presented to the wearer and/or differences in the two displays orimages shown to each eye. For example, the treatment protocol can bebased on a dichoptic presentation where images of differingcharacteristics are displayed to the wearer (e.g., different images orthe same image with the version of the image shown to the left and/orright eyes altered). In some implementations, the image shown to theweaker eye can be enhanced and/or the image shown to the stronger eyecan be diminished. For example, the image shown to the weaker eye can bealtered to be made more interesting or compelling to the wearer (e.g.,brightened, color-enhanced, three-dimensionally enhanced, sharpenedfocus, higher resolution, enhanced contrast, moving, higher refreshrate, etc.) Similarly, the image shown to the stronger eye can bealtered to be less interesting or less compelling to the wearer (e.g.,darkened, muted colors, flattened, blurred, lower resolution, lowercontrast, static, lower refresh rate, etc.). In various implementations,only the images shown to the weaker eye are altered while the imagesshown to the stronger eye are not altered. In various implementations,only the images shown to the stronger eye are altered while the imagesshown to the weaker eye are not altered. In various implementations, theimages shown both to the weaker eye and to the stronger eye are altered.The treatment protocol may include information on the duration of theprotocol. The treatment protocol may employ interactive virtual objects,thereby making the “treatment” more enjoyable to the user and increasinguser compliance to therapy regimen. The treatment protocol may employdynamic images (e.g., movies, games, etc.) to make the treatment moreenjoyable, thereby increasing compliance.

At block 1206, the ophthalmic system may detect or determine, based atleast in part on a scheduler attached to the treatment protocol, a timeor time window at which to start the treatment protocol. For example,the treatment protocol may be programmed such that re-training of theeye is to be performed daily at 10 PM or somewhere between 8 AM and 9AM. The treatment protocol may only be prescribed once every week, forexample. The treatment protocol can involve more treatment sessions suchas at least twice a week, at least five times a week, every day and/ormultiple times of day, such as at least, one, two, three, four, or fivetimes a day. In some embodiments, the treatment protocol may beprogrammed in response to detecting that the eyes are becoming more orless misaligned. In various embodiments, the treatment protocol may beprogrammed to occur when the eyes have recovered from the previoustreatment protocol.

At block 1208, the ophthalmic system alters the field of view of one orboth eyes. This can include, for example, partially or fully occludingthe eye(s). In some embodiments, the ophthalmic system may presentdifferent images to each eye, sometimes in different locations withinthe field of view, to either strengthen a weaker eye or promote propervergence for image fusion within the brain. It should be appreciatedthat this is simply one example technique, and many other techniques maybe used to strengthen or re-train the muscles of the eyes. The occlusionmay be a partial or complete occlusion. Full or partial defocus,blurring, attenuation, or other alteration to images presented to thewearer may be used as well.

In some embodiments, the ophthalmic system may skip block 1208. Forexample, in some treatment protocols, the respective fields of view ofthe stronger eye and the weaker eye are not altered. The ophthalmicsystem may present images of different visual characteristics to thewearer's eyes to encourage the weaker eye to gain strength.

As described herein, the content shown to the respective eyes can differas well, whether or not the field of view of one or both of the eyes isaltered. For example, less intriguing content can be shown to the weakereye. This may be accomplished by projecting images to the weaker eyethat are brighter, higher resolution, more complete, moving, highercontrast, three-dimensional, color-enhanced, from a plurality of depthplanes, etc. As another example, less intriguing content can be shown tothe stronger eye. This may be accomplished by projecting images to thestronger eye that are duller, lower resolution, missing portions,static, lower contrast, flattened, color-muted, from a single depthplane, etc. Intriguing content can be projected to the weaker eye at thesame time as less intriguing content can be projected to the strongereye, thereby encouraging the weaker eye to gain strength.

At block 1210, the ophthalmic system projects stimulatory imagesattracting the attention of the weaker eye. These stimulatory images maybe presented at prescribed locations and/or with enhanced visualcharacteristics—color saturation, contrast, resolution, depth cues,three-dimensional effects, brightness, intensity, focus, etc., therebyencouraging the eyes to focus and/or converge at a targeted locationand/or encouraging the visual content from the weaker eye to strengthenit. The virtual images can be moved over time and at a rate designatedby the treatment protocol to draw the eyes together at points ofvergence across multiple depth planes. When the eyes align at a commonpoint of vergence, the images from each eye fuse and the brain sees oneimage instead of two. This may be achieved in the form of a game, forexample.

In various embodiments, for example, the ophthalmic system can beconfigured to simultaneously present images to both eyes (dichoptic) fortreatment or therapeutic purposes. The images presented to respectiveeyes can differ in visual characteristics. This difference can increaseperformance of a weaker eye over time. For example, to provide astereoscopic image to the wearer, left and right images can be presentedto the wearer. During treatment, the image corresponding to the weakereye can be enhanced relative to the stronger eye. Enhancement of theimage can include, for example and without limitation, increasingbrightness of the image, increasing contrast of the image, increasingcolor saturation of the image, increasing intensity of the image,increasing three-dimensional effects of the image, adding content to theimage, etc. Similarly, the image corresponding to the stronger eye canbe diminished. Diminishment of the image can include, for example andwithout limitation, decreasing color saturation of the image,attenuating or decreasing intensity of the image, flattening the image,blurring the image, de-focusing the image, shadowing the image,partially or completely occluding the image, etc. In certainimplementations, de-focusing the image can be accomplished by presentingimages to the respective eyes from different depth planes. For example,multiple waveguides and associated lenses or other elements with opticalpower can be used to project images from different depth planes. In someembodiments, treatment can include enhancing images to the weaker eyeand diminishing images to the stronger eye. In certain embodiments,treatment can include enhancing images to the weaker eye while notaltering images to the stronger eye. In various embodiments, treatmentcan include diminishing images to the stronger eye while not alteringimages to the weaker eye. The enhancement and/or diminishment of imagescan be applied gradually and/or intermittently. For example, the qualityof an image can be gradually enhanced or diminished every 30-60 secondsand/or when the ophthalmic system the eyes become more misaligned. Asanother example, an image can be enhanced or diminished for a timeperiod and then that effect can be removed for a second time period.This can be alternated over the treatment period.

Treatment can also include, in some embodiments, varying depth planesfrom which images are presented. This can be similar to a Brock stringwhere multiple depth planes are used to re-train eyes with convergencedeficiencies. Images are projected from various depth planes, therebyallowing the eyes to converge and focus on images at varying depths.Varying depth planes can also be used to provide treatment similar topencil pushups. This treatment includes presenting an image at a firstdepth plane (e.g., about 1 foot away or farther) and then moving theimage closer to the wearer to a second depth plane. Moving the image caninclude gradually moving the depth plane closer to the wearer from thefirst depth plane to the second depth plane. While the image is beingpresented at this closer depth plane, the depth of the image can beadjusted so that the wearer can practice focusing on the image in aregion where it is difficult to focus (e.g., the wearer has difficultiesconverging on the image). This treatment also includes providing animage at a third depth plane that is farther away than the first andsecond depth planes. While the image is being presented at the seconddepth plane, the wearer can alternate between focusing on the image atthe second depth plane and the image being presented at the third depthplane. This can strengthen eye muscles, for example. These methods canbe combined with enhancement and/or diminishment of images duringtreatment.

Treatment can include, in some embodiments, selective occlusion of oneor both eyes. This can be done to present visually stimulating images ata targeted portion of the retina to increase effectiveness of thetreatment. In some embodiments, the ophthalmic system is configured touse selective occlusion to block portions of objects seen by the wearerusing, for example, spatial light modulators, shutters, or the like.Spatial light modulators can as described herein, for example, can beused. Adaptive optics, may also be used to redirect the light. Selectiveocclusion also includes intermittently occluding images in an eye. Thiscan be done to alternate images to the eyes (e.g., alternate betweenpresenting an image to the left eye and then to the right eye).

Treatment can include, in some embodiments, minor adjustments to acompensating prism correction to gradually influence convergence of theeyes. For example, the amount of compensating prism correction and/orlateral image shift can be reduced during treatment to influence aweaker eye to converge to a targeted point. The amount of compensatingprism correction and/or lateral image shift can be reduced over timeduring a single treatment or over the course of multiple treatments.

At block 1212, the system detects the end of the prescribed time for thetreatment protocol or possibly by detecting normal characteristics inthe function of the eye for accommodation, vergence, etc. At such time,the ophthalmic system discontinues treatment at block 1214. This caninclude terminating occlusion or de-emphasis of the eye of the wearer,if occlusion or de-emphasis had been applied. In some embodiments, thewearer may manually administer the treatment protocol based on thewearer's schedule. Similarly, many other such treatment protocols may beenvisioned.

In some embodiments, at block 1212, the ophthalmic system determinesthat the treatment should be discontinued by tracking performance of thewearer during treatment. When the wearer shows signs of fatigue or alack of compliance, the ophthalmic system discontinues treatment atblock 1214. For example, the ophthalmic system can include an eyetracking system that is configured to detect gaze of the wearer. The eyetracking system may detect that the wearer's performance duringtreatment (e.g., the wearer's ability to successfully focus on theimages being presented) has deteriorated over time. This may indicatethat the wearer has tired and further training or treatment would havelimited benefits. In some embodiments, the ophthalmic system can trackthe performance of the wearer over time to determine whether theconvergence deficiencies of the wearer are decreasing over time (e.g.,during a single treatment and/or over multiple treatment sessions).

In some embodiments, at block 1212, the ophthalmic system receives userinput indicating that the treatment should be discontinued. When suchuser input is received, the ophthalmic system discontinues treatment atblock 1214.

In some embodiments, at block 1212, the ophthalmic system automaticallydetects performance of the user during the administered treatmentprotocol. In block 1212, the ophthalmic system can be configured toreturn to block 1204 to update or adjust the treatment protocol based onthe detected performance of the wearer during the administered treatmentprotocol. For example, if the angle of convergence of the weaker eyedoes not improve during treatment, the ophthalmic system can adjust thetreatment protocol parameters and proceed with the method 1200 startingagain at block 1204. In this way, the ophthalmic system can use thewearer's performance during testing as feedback to make adjustments tothe treatment protocol and/or to determine when to terminate thetreatment.

In various implementations, the ophthalmic system can be configured toterminate the treatment protocol prior to finishing. For example, if theophthalmic system detects fatigue in the eye (e.g., the angle ofconvergence gets worse for weak eye), the ophthalmic system can beconfigured to terminate the treatment protocol at block 1212 byproceeding to block 1214.

Similar to strabismus, amblyopia or “lazy eye” is a condition in whichone of the eyes is weaker than the other. This may be caused by thebrain's preference to favor the inputs the stronger eye over the weaker.In some embodiments, the ophthalmic system may be programmed to performa method similar to the method 1200 described with reference to FIG. 12to enhance the visual stimulus to, and thereby gradually strengthen, theweaker eye and/or to reproduce the effects of an eye patch byselectively dimming an intensity of light or decreasing the level ofvisual stimulus entering the stronger eye. Other treatment and trainingsystems and techniques as described above, for example, with referenceto Strabismus may also be employed.

In various embodiments, to reduce distraction the view of the world infront of the wearer's eyes through the augmented reality device isblocked or otherwise not visible during examination and/or treatment. Aspatial light monitor that adjusts intensity, such as a liquid crystalspatial light modulator or shutter, for example, may be used. This canoccur, for example, when images are presented to the viewer, althoughthis approach is not necessary.

Although the system has been described as an augmented reality device,in other embodiments the system may be a virtual reality device. Ineither case, the system may be an ophthalmic system provided by thephysician or clinician for testing at a medical facility or optometristoffice or elsewhere. In other embodiments, the system may belong to thewearer and may be employed for other purposes such as entertainment(e.g., games and movies) and/or work activities. As described above, onebenefit of implementing treatment on the wearer's system is that theexamination can be conveniently undertaken multiple times (at least 2,3, 4, 5, 6, 8, 10, 12, 16, 18, 24, or more times a year) at the wearer'sdiscretion. Likewise, examination can be performed with or without amedical professional, such as optometrist, ophthalmologist, nurse,technician, medical assistant, etc.

Higher Order Aberrations

Other common eye-related ailments include high order refractive errors,which may include any wavefront curvature corrections that cannot bemade with prism and/or lens corrections. These higher order aberrationsmay account for 10% of all refractive errors. These higher orderrefractive errors may be the results of irregularly shaped opticalsurfaces in the eye, and are particularly common after refractivesurgeries. For example, shape irregularities in the in the cornea and/orcrystalline lens of the eye may introduce higher order refractive errorsto light that passes through the eye to the retina. Such higher orderaberrations may potentially be reduced with appropriate refractivecorrection.

Various implementations of the ophthalmic systems described herein maybe applicable for providing correction to wavefronts for these higherorder aberrations. It should be appreciated that almost all wavefrontcorrections, up to and including all aberrations described by Zernikemodes (e.g., astigmatism, coma, trefoil, spherical aberrations,quatrefoil, etc.) may potentially be made utilizing the ophthalmicdevice described herein.

In some implementations, the ophthalmic system may also be configured tocorrect microscopic defects in the cornea, crystalline lens and othertransmissive media of the eye. These defects can generate complexrefraction, reflection, and scattering patterns that have the effect ofvisual quality impairment.

In various embodiments, the ophthalmic system may detect patterns in theprojected light caused by these defects through, for example, aneye-tracking system or other camera or imaging system. This informationmay be used by the ophthalmic system to selectively filter out incomingrays of light onto the user's eye that would interact with these defectsof the eye, thus blocking optical pathways that contribute to impairedvisual quality.

The ophthalmic system may, for example, be a patient-worn ophthalmicdevice as illustrated in FIGS. 3A-3D and 5, and as described above inconnection with correcting for myopia, hyperopia, astigmatism, and otherrefractive errors. Accordingly, it will be understood that featuresdiscussed in connection with the description included above related tothe ophthalmic device for correcting for vision defects such as myopia,hyperopia, and astigmatism applies equally in relation to correcting forhigher order aberrations. In particular, the ophthalmic device may beconfigured to provide optical correction to reduce or correct forrefractive error, including higher order aberrations. The device, forexample, may include adaptive optics or variable focus elements thatintroduce wavefront correction and can be used to introduce, not onlysphere and cylinder to offset defocus and astigmatism, but may also beused to reduce higher order aberrations resulting from the wavefrontshape.

As describe above, the ophthalmic device may include an augmented (orvirtual) reality display device (62) that includes in a display lens(106) and a light source configured to project light (38) that isdirected into the eyes of a user to form images in the eye of the userfor the user's viewing. In various embodiments, this display device (62)comprises a waveguide stack (178) that receives light from a fiberscanning display disposed at the edge of the waveguide stack (178) andcouples the light out of the waveguide from the backside thereof to thewearer's eyes. In the case where the display device (62) is an augmentedreality display device, the ophthalmic device may also direct ambientlight from the surrounding world to the eyes of the user through displaylens (106), e.g., light from in front of the user. This light may, forexample, be transmitted through the waveguide stack (178) to thewearer's eye. As discussed above, the display device (62) may alsocomprise one or more adaptable optics or variable focus elements (VFEs).As described above, the adaptable optics may be an optical element thatcan be dynamically altered so as to alter the wavefront incidentthereon. For example, the adaptable optic may be a reflective opticalelement such as a deformable mirror or a transmissive optical elementsuch as a dynamic lens, such as described above in FIGS. 10B-10E.

In some embodiments, the projected light (38) forming an image generatedby the ophthalmic system may be incident on the one or more adaptableoptics or VFEs as described herein. The adaptable optics may be areflective optical element such as a deformable mirror or a transmissiveoptical element such as a dynamic lens (e.g., a liquid crystal lens, anelectro-active lens, a conventional refractive lens with movingelements, a mechanical-deformation-based lens, an electrowetting lens,an elastomeric lens, or a plurality of fluids with different refractiveindices). The adaptable optics may receive the light having an incidentwavefront from a fiber scanning display. The wavefront may be modifiedto compensate for higher order aberrations by the adaptable optic, asdescribed herein. This corrected or compensated wavefront may then passthrough a transmissive beamsplitter and be directed into the eyes of theuser.

In some embodiments, alternatively or in combination, adaptable opticscomprises a spatial light modular configure to modify phase on a pixelby pixel basis. Optical correction can therefore be imparted on thewavefronts. In various embodiment therefore, the ophthalmic device maybe configured to drive the light modulator to compensate for chromaticaberrations.

In one or more embodiments, the ophthalmic system may comprise one ormore sensors or subsystems configured to determine higher orderaberrations in one or more eyes of the user. In one implementation, theophthalmic system may utilize wavefront aberrometry technology such asdescribed herein to evaluate refractive defects in the eye. In someembodiments, for example, the ophthalmic device may include cameras (24)and light sources (26), and be configured to be utilized an aberrometer.For example, as described below in reference to aberrometry technology.In some embodiments, the cameras (24) are infrared cameras a. Thecameras (24) may be operatively coupled to the local processing module(70) to detect higher order refractive defects in the eye.

Similarly, one or more camera or imaging system may be employed toidentify regions of the eye, for example, the cornea, crystalline lensand other transmissive media of the eye, that have microscopic defectsthat generate complex refraction, reflection, and scattering patternsthat reduce the quality of vision. In response, the display can bedriven so as not to direct light to said regions with defect.

Additionally, in some embodiments, the ophthalmic device may include oneor more transmitters and receivers to allow transmission and receptionof data between the ophthalmic device and the remote processing module(72) and/or remote data repository (74). The transmitter and receivermay be combined into a transceiver. In some embodiments the remoteprocessing module (72) and/or remote data repository (74) may be part ofa third party server and database that enable a third party (e.g., adoctor or other medical administrator) to transmit data, such as forexample, an optical prescription, to the ophthalmic device.

In some embodiments, the various components of the ophthalmic device maybe operatively coupled to a local processing module (70). Localprocessing module (70) may be operatively coupled to a digital memory,and comprise instructions, that when executed, cause the ophthalmicdevice to correct for higher order refractive aberrations in the eye.

In some embodiments, the ophthalmic system may be an augmented realitysystem that corrects for higher order refractive errors. As describedabove, the ophthalmic system may be an augmented reality head mounteddisplay system configured provide wavefront correction to ambient lightfrom the world in front of the user, as well as providing wavefrontcorrection to AR image content generated by the ophthalmic system.Alternatively, the ophthalmic system may be a virtual reality headmounted display system configured to produce VR image content generatedby the ophthalmic system having a corrected wavefront and provided tothe user while the user's eyes are covered from ambient light in frontof the user by the VR head mounted display system. As describedpreviously, a VR head mounted display system may include outward facingcameras configured to capture ambient light from the world in front ofthe user and generate corrected wavefronts of these images.

In some embodiments, the process flow for correcting for higher orderaberrations may be similar to process flow 1000 of FIG. 10A describedfor correcting for myopia, hyperopia, or astigmatism. In someembodiments, process flow 1000 may be performed by patient-wornophthalmic devices, such as those described in connection with FIGS.3A-3D. The process flow 1000 can be implemented by the local processingmodule (70), for example, by the remote processing module (72) executedby logic devices in the local processing module (70) operably connectedto the remote data repository (74). Adaptive optics or VFEs such aselectrically reconfigurable mirrors or lenses such as lenses located asshown in FIGS. 10B-10E may be used to provide refractive correctionbased on the user's optical prescription.

At 1002, the ophthalmic system determines a user's optical prescription,e.g., the higher order aberrations due to irregularly shaped opticalsurfaces in the eye (e.g., shape irregularities in the cornea and/orcrystalline lens of the eye). As described above, the ophthalmic devicemay include a user interface whereby the user inputs an opticalprescription or the ophthalmic system may go through an eye-prescriptionconfigurator program to determine higher order refractive errors of theeye. For example, the ophthalmic system may include an aberrometer, asdescribed herein. In some embodiments, the ophthalmic system may beconfigured to receive an optical prescription from a third party. Forexample, a doctor may be able to send a user optical prescriptionwirelessly (e.g., over the internet, Blue-tooth connection, etc.), whichis received by a receiver or transceiver and stored in the digitalmemory of the local processing module (70).

In some embodiments, at 1002, the ophthalmic system may detect patternsin light projected by the ophthalmic system that is caused by the higherorder refractive defects in the eye. For example, the light source (26)may be configured to project infrared light into the eye and the camera(24) may detect the infrared light reflected from the eye due to higherorder refractive defects in the eye. Based on the detected reflected orscattered light, the ophthalmic device may detect a pattern thatcorresponds to higher order aberrations.

At 1004, the ophthalmic system retrieves a mapping table to determine anappropriate image modification program to correct for higher orderrefractive errors. In some embodiments, the mapping table comprises anassociation of different optical prescriptions to different imagemodification programs. For example, for a given optical prescription ofthe user, the mapping table may list an image modification programconfigured to compensate for the higher order aberrations as defined bythe optical prescription.

In one embodiment, an image modification program defines modificationsto the incident wavefront (e.g., modifications to the phase) to generatea compensating wavefront. In another embodiment, the image modificationprogram defines modification to one or more 2D (e.g., modification tothe intensity pattern) images generated by the ophthalmic system andpresented to the eye of the user. In some embodiments, each 2D image maybe a 2D representation of an image at a different focal depth providingthe user a 3D perception of the images. In one or more embodiments, theophthalmic system may be pre-coded with such programs, or these programsmay be downloaded in order to perform image modulation based on theprescription. See, for example, the description below in connection withphoropter technology. In some embodiments, the remote processing module(72) may be executed to retrieve or look up the mapping stored in theremote data repository (74).

As described above, the image modification programs may includeparameters to be applied to the VFE or adaptable optics of theophthalmic system based on the desired wavefront correction. Theparameters may define the modifications to be applied to the shapeand/or characteristics of the adaptable optics, thereby altering thewavefront to correct for higher order refractive errors. Theseparameters and corresponding set of signals may be based on the opticalprescription and/or detected aberration patterns of defects. Forexample, to correct for higher order refractive errors, the imagemodification program may have a set of parameters configured to encode acompensating wavefront curvature into the optics of the ophthalmicsystem (e.g., the VFE or adaptable optics of display device (62)). Thecompensating wavefront curvature may be such that the wavefront of animage that reaches the retina of the eye is corrected to account forrefractive error in the shape of the optical surfaces of the eye,thereby removing the high order aberrations caused by the eye.

Without subscribing to any scientific theory, the eye of a user mayexperience different higher order refractive errors and/or need foroptical correction depending on the focal depth that the eyes areaccommodating. Accordingly, in one or more embodiments the imagemodification program may comprise an association of the distances ofaccommodation of the eyes for a plurality of different depth planes(e.g., 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, or moredepth planes) and corresponding parameters to compensate for higherorder refractive errors associated with accommodating at different focaldepths. For example, the ophthalmic system may determine at least one ofthe user's eyes impart first higher order refractive error to anincident wavefront while accommodating at one focal depth, while theuser's eye imparts a second refractive error (e.g., requiring adifferent spherical wavefront) for another focal depth. Accordingly,different compensating wavefronts (e.g., based on different opticalprescriptions) may be associated with different focal depths ofaccommodation, depending on different higher order aberrationsexperienced by the user at different focal depths.

In some embodiments, encoding a corrected wavefront comprises modifyingthe wavefronts of ambient light passed to the user from the surroundingworld, e.g., in front of the user and ophthalmic system. Similarly,encoding a corrected wavefront may comprise modifying the wavefront theimage generated by the ophthalmic device and projected by the displaydevice to the user. For example, as described above, an electricalsignal may be applied to electrodes coupled to the adaptable optics thatalters the shape or optical characteristics of the adaptable optics.This in turn may alter the wavefront that incident on the adaptableoptics. In some embodiments, the wavefront of the ambient light and anyprojected images may be both modified by either a single VFE oradaptable optics or independently by different VFE or adaptable optics.In some embodiments, where the ophthalmic system is a VR head mounteddisplay, outward facing cameras may obtain images of ambient light infront of the user, the wavefront of which may be altered as describedherein.

In some embodiments, where the ophthalmic system detects patterns inreflected light that is indicative of refractive errors, the imagemodification program may be configured to selectively filter out rays oflight projected into a user's eye that interact with the defects of theeye, thus blocking optical pathways that contribute to impaired visualquality. For example, based on the correlation of the mapping of the eyewith the high order aberrations, the ophthalmic system may identify oneor more rays of light that may interact with the defects in the eye,resulting in the high order aberrations. Once identified, the ophthalmicsystem may determine to filter these rays of light from the wavefrontincident on the optics. Accordingly, since those rays of light do notinteract with the defects, the high order aberrations do not impair thevisual quality of images presented to the user by the ophthalmic system.

In some embodiments, the remaining steps of process flow 1000 may becarried out in the same manner as described above for correcting formyopia, hyperopia, and astigmatism. Thus, at 1006, the ophthalmic systemselects the appropriate image modification program to apply to theimages projected to the user by the display of the ophthalmic device.For example, the ophthalmic system may select an image modificationprogram based on the mapping information. In this embodiment, the imagemodification program may alter a portion of the incident wavefront tocompensate for a portion of the eye having refractive defects. At 1008,the ophthalmic system may apply the image modification program tocorrect the wavefront of the projected images. At 1010, the ophthalmicsystem may project the corrected wavefront of the image to the userthrough the display of the ophthalmic system. In various embodiments,the ophthalmic system may automatically apply the high order refractiveerror correction to an incident wavefront based on information storedremotely (e.g., external to the ophthalmic device), for example, atremote data repository (74).

In some embodiments, where the ophthalmic device is an augmented realityhead-mounted display system, wavefront correction may be applied to animage to be presented to the wearer by the ophthalmic device whileimaging objects located in front of the head mounted display and theuser. For example, AR image content presented by the ophthalmic systemmay be modified and projected in combination with ambient light. In someembodiments, the ambient light passing from the outside world throughthe lens 106 may also be modified by the appropriate program to provideoptical correction for a wearer viewing the outside world through thelens 106. In another embodiment, in the case of a VR head mounteddisplay system that is opaque to the world in front of the user, themodified image may be a modification of a VR image provided by theophthalmic system and the display therein for visual representation, forexample, a VR image content.

In various embodiments, the process flow 1000 may be implemented as adynamic vision correction system as described above. For example, theadaptable optics can be driven by electrical signals that change theshape and/or characteristics of the adaptable optics. The alteredcharacteristics of the adaptable optics may then change the shape of awavefront incident on the adaptable optics to produce a correctedwavefront. This wavefront correction by the ophthalmic system may bechanged in real-time as the optical prescription of the user changesover time. For example, the refractive defects of a user's eye maychange as the user ages. In some embodiments, at 1010 the ophthalmicsystem may implement dynamic vision correction by initiating aneye-prescription configurator program. At 1010, the ophthalmic systemmay be configured return to 1002 and manually and interactivelydetermine the user's prescription at various points over time, in someembodiments, without user activation. Thus, the ophthalmic system maydynamically identify a first optical prescription at a first time andadjust the correction for refractive defects based on that prescription,and identify a second optical prescription at a second time and adjustthe correction for refractive defects based on that second prescription.

Chromatic Aberration

In various embodiments, the ophthalmic system may be used to compensatefor chromatic aberrations. Chromatic aberrations are errors resultingfrom colors (e.g., wavelengths) of an image interacting differentlywith, for example, the optics of the ophthalmic system or thecrystalline lens of an eye of the user. These chromatic aberrationsresult because a lens may have slight variations in the index ofrefraction for different wavelengths of light.

There are two types of chromatic aberrations, longitudinal chromaticaberrations and lateral chromatic aberrations. Longitudinal chromaticaberrations occur when different wavelengths of light focus to differentfocal points along the optical axis. Thus, each color of an image may befocused to a different focal depth. Lateral chromatic aberrations occurwhen different wavelengths of light are focused to a different positionon the focal plane of an optical system. Thus, colors of an image areshifted or displaced relative to each other, for example, laterallyalong the focal plane and perpendicular to the optical axis. Thus,longitudinal chromatic aberrations may cause a discoloration or fringingthroughout or anywhere in an image whereas lateral chromatic aberrationsmay not occur at the center of an image.

In one or more embodiments, the ophthalmic system may be configured tocompensate for longitudinal chromatic aberrations by projecting light ofdifferent wavelengths (e.g., different colors) at different focaldepths. An image to be projected by the ophthalmic system and viewed bya user may comprise multiple colors, thus, projecting light of differentwavelengths at different focal depths may compensate for longitudinalchromatic aberrations in viewing said image. As described herein, invarious embodiments, the ophthalmic device can function as a solid statevariable focus lens with an adjustable focus (e.g., adaptable optics orvariable focus element (VFE)). As described above, for example, incorrecting for myopia, hyperopia, or astigmatism, the ophthalmic systemmay be equipped with one or more adaptable optics or VFEs. The adaptableoptic may be dynamically altered for a given color, for example byapplying electrical signals thereto to change the shape of a wavefrontthat is incident thereon. By altering the adaptable optic's shape orother characteristics for a given color, the wavefront is changed inrelation to that color, for example to vary the focus of the wavefrontas described herein to compensate for chromatic aberrations.

In other embodiments, alternatively or in combination, the ophthalmicsystem can be configured to project light of different wavelengths atdifferent angles to compensate for lateral chromatic aberrations. Asdescribed herein, the display may comprise a fiber scanning device thatoscillates to create a 2D image pattern. To reduce lateral chromaticaberration, the beam that is projected from the display onto the retinato form the image on the retina for one color can be shifted. Forexample, the angle of the fiber can be shifted or offset. The amountthat this angle is shifted is different for different color components.Additionally or alternatively, by altering the angle of the beamprojected onto the eye (e.g., by offsetting the angle of the fiberscanning device or by providing an angular offset to the adaptableoptic's shape), the wavefront can be changed for a given color, forexample to vary the angle of incidence of the wavefront to compensatefor lateral chromatic aberrations. In various embodiments the light iscollimated but the angle of the beam changes as the beam is scanned towrite the image onto the retina. In some embodiments, changes to theangle of the beam is constant while scanned to write the image onto theretina. In other embodiments, changes to the angle of the beam may bevaried while the beam is scanned to write the image.

As described above, the ophthalmic device may include an augmented (orvirtual) reality display device (62) that includes a display lens (106)and a light source configured to project light (38) that is directedinto the eyes of a user to form images in the eye of the user for theuser's viewing. In various embodiments, this display device comprises awaveguide stack that receives light from a fiber scanning displaydisposed at the edge of the waveguide and couples the light out of thewaveguide from the backside thereof to the wearer's eyes. In the casewhere the display device is an augmented reality display device, theophthalmic device may also direct ambient light from the surroundingworld, e.g., light from in front of the user, to the eyes of the userthrough display lens (106). This light may, for example, be transmittedthrough the waveguide stack to the wearer's eye. As discussed above, thedisplay device (62) may also comprise one or more adaptable optics orvariable focus elements (VFEs). As described above, the adaptable opticsmay be an optical element that can be dynamically altered so as to alterthe wavefront incident thereon. For example, the adaptable optic may bea reflective optical element such as a deformable mirror or atransmissive optical element such as a dynamic lens, such as describedabove in FIGS. 10B-10E. Spatial light modulators that modulate the phasecan also be employed. Such phase modulators may operate in transmissionor reflection. A liquid crystal spatial light modulator may, forexample, be employed.

In some embodiments, the ophthalmic system may be configured tocompensate for chromatic aberrations based on a predetermined opticalprescription of the user, chromatic aberrations due to the optics ofembodiments of the ophthalmic system described herein, or both. Forexample, the light passed through the eye of the user may impart achromatic aberration to the light received at the retina. The chromaticaberrations due to the eye may be determined based on an opticalprescription or an eye-prescription configurator program executed by theophthalmic system, as described below in reference to FIG. 10A.Similarly, light passed through the optics of the ophthalmic system mayalso impart some chromatic aberrations onto the light incident on theeye and eventually received at the retina. Chromatic aberrations due tothe system may be known based on the specifications and manufacturingrequirements of the system. The ophthalmic system may be configured toutilize these pre-determined aberrations and compensate for them whenprojecting an image to the eye of the wearer.

When the system compensates for chromatic aberrations, not all thechromatic aberration need be removed. For example, as described inreference to light therapy herein, blue light may be especially damagingto retinal cells. Thus, the ophthalmic system may be configured tocontrol the chromatic aberration correction to reduce the amount of bluelight incident on the retinal cells of the eye. In other embodiments,alternatively or in combination, some chromatic aberrations maycontribute to creating a realistic focus of depth cue for a given user.Thus, the compensation of chromatic aberration may be controlled topermit some aberrations while correcting others to provide optimalvision quality. The system, however, does reduce the effects ofchromatic aberrations as viewed by a wearer of the ophthalmic system.

In some embodiments, an ophthalmic system may be configured to correctfor chromatic aberrations may be similar to the ophthalmic systemdescribed above for correcting for myopia, hyperopia, and/orastigmatism. In some embodiments, the ophthalmic system may beconfigured to correct for chromatic aberrations along with myopia,hyperopia, astigmatism, or other refractive errors.

As discussed above, for example, the ophthalmic system may be apatient-worn ophthalmic device as illustrated in FIGS. 3A-3D and 5 thatmay be implemented to compensate for chromatic aberrations. Theophthalmic device may include a display device (62) that includes alight source (18) configured to project light (38) that is directed intothe eyes of a user in a display lens (106) of the display device (62).The ophthalmic device may also direct ambient light from the surroundingworld to the eyes of the user through display lens (106), e.g., lightfrom in front of the user.

In various embodiments, the ophthalmic device includes outward facingcameras configured to capture ambient light from the environmentsurrounding the user. For example, the ophthalmic device may include oneor more wide-field-of-view machine vision cameras (16) operativelycoupled to a local processing module (70). These cameras may beconfigured to obtain images of the environment around the user, forexample, an image of the environment in front of the ophthalmic deviceand user. In one embodiment these cameras (16) are dual capture visiblelight/infrared light cameras. Images taken by cameras (16) may be storedin a digital memory of the ophthalmic device and retrieved forsubsequent processing.

In various embodiments, the ophthalmic device may comprise a biofeedbacksystem, as described herein, configured to determine a comfort level ofthe user in viewing an object or image. For example, if a user's eyesare shifting, changing accommodation, changing in pupil size, changingvergence, etc., these may be indicators that the user is unable tocomfortably view an object or image. Instability or oscillation inaccommodation or behaviors associated with accommodation may be a signthe user is struggling with focusing on an object or image. Accordingly,the biofeedback system may receive real-time inputs relating to thestate of the user's eye.

The light source (18) may be configured to project light (38) into theeyes of a user to form an image in the eye of the user. Accordingly, theimage may include image content displayed by the ophthalmic device andprojected in to the eyes of the user through display lens (106), forexample, based on images stored in the digital memory of the localprocessing module (70). In one implementation, the images stored in thedigital memory may be images obtained by outward facing cameras (e.g.,cameras (16)). In various embodiments, images formed on the retina mayinclude images formed from ambient light from objects in front of theuser that reach the eyes of the user through display lens (106). Invarious embodiments, the images on the retina may include a plurality ofcolor components. The color components, for example, may be red, green,or blue components. These color components may include portions of theimage having the same color or all portions of the same color. Forexample, an image may comprise various portions having the color blue(e.g., a first color component) and various other portions having thecolor red (e.g., a second color component). While the color componentsare described as being red, green, or blue, it will be understood thatany color of an image may be applicable and the number of componentsneed not be limited to three. There may be any number of colorcomponents, based on the colors of the image. In other embodiments, theimage may be monochromatic image, comprising a single color component.

The display device (62) also comprises one or more variable focuselements (VFEs) or adaptable optics. As described above, the VFEs oradaptable optics are configured to be dynamically altered so as to alterthe wavefront incident thereon. For example, the adaptable optic may bea reflective optical element such as a deformable mirror or atransmissive optical element such as a dynamic lens, such as describedabove in FIGS. 10B-10D. As described above in FIG. 10E, the VFEs oradaptable optics may be included in the display lens (106) or locatedbetween the display lens (106) and the light source. The VFEs oradaptable optics may also be integrated into a waveguide stack or lightsource (18). Furthermore, the VFEs or adaptable optics may be positionedbetween the waveguide stack and the world in front of the ophthalmicdevice and user. The VFEs or adaptable optics may also be positionedbetween the waveguide stack and the eye of the user. In anotherembodiment, the adaptable optics may be positioned between waveguides ofthe waveguide stack.

In one embodiment, the display device may comprise a waveguide stack,for example, the waveguide stack (178) described above in connectionwith FIG. 10D. The stacked waveguide assembly (178) comprisestransmissive beamsplitter substrates, each of which is configured toproject light at a different focal plane or as if originating from adifferent focal plane. The waveguide stack (178) may comprise aplurality of waveguides (182, 184, 186, 188, 190) and a plurality oflenses (198, 196, 194, 192) configured to selectively send imageinformation to the eye with various levels of wavefront curvature foreach waveguide level indicative of focal distance to be perceived forthat waveguide level. A plurality of displays (200, 202, 204, 206, 208),or in another embodiment a single multiplexed display or reduced numberof multiplexed displays, may be utilized to inject light, e.g.,collimated light with image information into the waveguides (182, 184,186, 188, 190), each of which may be configured to distribute incominglight substantially equally across the length of each waveguide, forexit down toward the eye.

The waveguide (182) nearest the eye may be configured to delivercollimated light, as injected into such waveguide (182), to the eye,which may be representative of the optical infinity focal plane. Asdescribed above in more detail, the other waveguides may be configuredto represent focal planes closer than infinity at a range of diopters,giving the user 3D perception of images generated by the ophthalmicsystem as different image content from different waveguides will appearto originate from different depths or distances from the user. Thedifferent image content from different waveguides may be configured tobe different color components of the image. Thus, each color component(e.g., red, green, blue) may appear to originate from a different focaldepth.

For example, the next waveguide up (184) ca be configured to send outcollimated light of a first color component which passes through thefirst lens (192; e.g., a negative lens) before it can reach the eye(58); such first lens (192) may be configured to create a slight convexwavefront curvature so that the eye/brain interprets light of the firstcolor component coming from that next waveguide (184) as coming from afirst focal plane closer inward toward the person from optical infinity.Similarly, the third waveguide (186) passes its output light of a secondcolor component through both the first (192) and second (194) lensesbefore reaching the eye (58); the combined optical power of the first(192) and second (194) lenses may be configured to create anotherincremental amount of wavefront divergence so that the eye/braininterprets light of the second color component coming from that thirdwaveguide (186) as coming from a second focal plane even closer inwardtoward the person from optical infinity than was light from the nextwaveguide (184).

In some embodiments, the number of waveguides may correspond to thenumber of color components having its focal depth varied to compensatefor chromatic aberrations. For example, where color components are red,green, and blue, the waveguide stack (178) may comprise threewaveguides, one for each color component. However, in variousembodiments, the waveguide stack may include other waveguides beyondjust these three. For example, three waveguides, one for each colorcomponent may be included for each depth plane. Additional waveguidesmay also be added. Also, less waveguides may be employed.

As described above, the adaptive optics may be adjusted to correct forthe chromatic aberration. In particular, the adaptive optics can beadjusted to provide different optical power when each of the colorcomponents is emitted. For example, at a first time a red light sourcewould inject light into a corresponding waveguide, and the adaptiveoptics could be adjusted to provide a first optical power to theadaptive optics so the red light is focused on the retina. At a secondtime a green light source would inject light into a correspondingwaveguide, and the adaptive optics could be adjusted to provide secondoptical power, different than the first optical power, to the adaptiveoptics so the green light is focused on the retina. At a third time ablue light source would inject light into a corresponding waveguide, andthe adaptive optics could be adjusted to provide third optical power,different than the first and second optical powers, the adaptive opticsso the blue light is focused on the retina. According, the focal depthof each color component of an image may be selectively altered to reducechromatic aberration thereby reducing longitudinal chromatic aberration.

In various embodiments therefore, the display device (62) comprisesadaptable optics or VFEs, for example, similar to VFE (1020) describedin FIGS. 10B and 10C. In some embodiments, the VFEs or adaptable opticsmay be altered as to modify the phase and/or focus of the wavefront of agiven color component of an image incident thereon. As described above,the shape of the VFE (1020) may be modified, thus varying the phase,wavefront shape, and possibly the focus of the light incident thereon.Thus, the shape of the VFE may be modified to adjust the focal depth ofa given color component of the wavefront incident thereon. For example,where the VFE or adaptable optic is an adaptive optic lens VFE (1020),the VFE (1020) can be coupled to a set of electrodes (1022) that arethen selectively controlled in order to modify the shape or index of thematerial comprising the lens, and consequently change the focus of thelight. The adaptive optics lens may comprise, for example, elastomericmaterial having a shape that can be manipulated by applying voltage orelectric field. The electrodes (1022) may thus be controlled in a mannersuch that the shape of the VFE (1020) complements the chromaticaberrations such that the image may be appropriately viewed by theuser's eye. For example, a first color component may be project and theadaptable optic may be modified to have a first focal depth, and asecond color component may be project and the adaptable optic may have asecond focal depth. The adaptable optic may be changed in real-time at ahigh enough rate to be unperceivable to the user, thereby variablyaltering the incident wavefront to correct of chromatic aberrations.

In some embodiments, the shape of the VFE or adaptable optics may beselectively modified so as to vary the position of different images ofdifferent color components. The positions may be varied as tosubstantially align the different images. In some embodiments, the shapeof the VFE or adaptable optics may be selectively driven so as to modifythe wavefront of the light forming an image so as to change the angle ofincidence at which light of different color components is projected ontothe eye. Thus, a first color component may be shifted from a firstposition to a second position on the focal plane. The second positionmay be configured to correct for lateral chromatic aberrations, suchthat the first color component is focused at approximately the sameposition as at least a second color component on the focal plane. Insome embodiments, the position of the second component is focused on thefovea of the eye.

In yet another embodiment, alternatively or in combination, light source(18) of the ophthalmic device may comprise a fiber scanner, or otherlight generating source, that is configured to vary focus in a rasterpattern across the retina. The fiber scanner may be configured togenerate a raster pattern of a plurality of color components, where eachcolor component projects a color component of the image and are focusedat a different focal depth. For example, the longitudinal position ofthe fiber can be translated to change the focus. Accordingly, theophthalmic device may be configured to compensate for longitudinalchromatic aberrations.

In some embodiments, the ophthalmic device may include one or moretransmitters and receivers to allow for the transmission and receptionof data between the ophthalmic device and the remote processing module(72) and/or remote data repository (74). The transmitter and receivermay be combined into a transceiver. In some embodiments the remoteprocessing module (72) and/or remote data repository (74) may be part ofa third party server and database that enable a third party (e.g., adoctor or other medical administrator) to transmit data, such as forexample, an optical prescription, to the ophthalmic device.

In various embodiments, the ophthalmic device may comprise a feedbackmechanism (e.g., a user interface) that may be configured to determinean optical prescription. In some embodiments, for a color component, theuser may be able to manually adjust the focus of the variable focuslenses by providing input to the system, for example, to increase ordecrease a power of the optics, or the focus of the images beingpresented to the user. The user input may cause the one or moreadaptable optics to change shape thereby altering the focus of thewavefront to cause the associated light and image to focus on theretina. The user can perform this process for each of the colorcomponents. In another embodiments, the system may be configured toautomatically or interactively determine an optical prescription of auser (e.g., by employing phoropter technology as described herein) andincorporate the optical prescription in the optical sub-parts of theophthalmic system. For example, the ophthalmic system may objectivelydetermine a prescription based on a biofeedback system, as describedherein. The system can perform this process for each of the colorcomponents.

In one or more embodiments, the ophthalmic system may comprise one ormore sensors configured to assess whether the user can view an imagecomfortably, e.g., when the user is struggling to focus on the image.For example, the ophthalmic system may utilize gaze orientation, headposition, fluctuations or changes in accommodation and/or vergence,and/or eye movement, possible pupil size, and possible shape of thenatural lens to determine whether the user can view an image comfortablyas described herein. Inwardly facing cameras or other instrumentation,e.g., SLO, may be used to monitor eye to make this assessment.

For example, the display device (62) may include gyroscopic sensorsconfigured to determine head position or head movement of the user(e.g., straight, tilted down, looking up, etc.). Movement of the user'shead may be indicative of a user searching for a better viewing angle ofthe image. In some embodiments, the display device (62) may comprise asensor assembly (39) having accelerometer, gyroscope, and/or other typesof orientation and/or movement sensors various of which are discussedelsewhere herein. The sensor assembly (39) may be configured to detectmovement imparted onto and orientation of the display device (62) due tomovement of the user's head. The display device (62) may also includeprocessor (32) (e.g., a head pose processor) operably coupled to thesensor assembly (39) and configured to execute digital and/or analogprocessing to derive head positions from movement detected by the sensorassembly (39). In one embodiment, sensor assembly (39) may generatemovement data stored in a digital memory. In some embodiments, themovement data may be used to reduce noise while diagnosing visualdefects (e.g., detecting a head movement during a test may be indicativeof a faulty test and result). The processor (32) may retrieve thismovement data and execute processing logic to determine one or more headpositions.

In another embodiment, the display device may include an eye trackingsystem configured to monitor movement of the user's eyes. For example,as described above, the eye tracking module may be configured todetermine changes in gaze orientation as the eyes move about and/orchanges in convergence point of the eyes. In some embodiments, the eyetracking module may be configured to monitor for fluctuations inaccommodation and accommodation reflect (e.g., fluctuations inaccommodation and vergence). Such movement may also be indicative of auser searching for a better viewing angle or focus of the image. Asdescribed above, the eye tracking system may comprise inward facingcameras, for example, cameras (24), to track the each eye, which can beoperatively coupled to the local processing module (70). The localprocessing module (70) may include software that, when executed, may beconfigured to determine the convergence point of the eyes, as describedabove in reference to FIG. 6 and/or the direction of the eyes.

In some embodiments, the various components of the ophthalmic device maybe operatively coupled to a local processing module (70). Localprocessing module (70) may be operatively coupled to a digital memory,and comprise instructions, that when executed, cause the ophthalmicdevice to compensate for chromatic aberrations.

In some embodiments, the local processing module (70) may includeinstructions that when executed are configured to compensate forchromatic aberrations. In some embodiments, this compensation need notbe implemented by the optics of display device (62). For example, animage projected by the ophthalmic system may be modified in a digitalmemory of local processing module (70) or remote from the ophthalmicsystem and executed by the local processing module (70). The ophthalmicsystem may generate a 2D image to be presented to the eye of a user, andthe system may be configured to modify this image prior to projectingthe image to compensate for chromatic aberrations. For example, thepattern or collection of pixels that form the image can be modified tocounter, offset, or reduce effects of errors introduced by the eye orthe optics of the ophthalmic system. For example, the pattern can beshifted laterally or radially. The modified pattern of one colorcomponent may be combined or superimposed onto the modified (e.g.,shifted) or unmodified pattern for the other color component andpresented to the eye of the user by the ophthalmic device through thedisplay device (62). The light field of a generated image (e.g., theangle, wavelength, and intensity) may also be modified to account forchromatic aberrations. In one embodiment, for example, the blue colorcomponent is shifted in one direction when presented by the display, thered color component is shifted in another direction when presented bythe display and the green color component is not shifted when presentedby the display. The eye will see all three color components, ideallysuperimposed. Similarly, the, the angle of an incident light ray may bechanged based on the lateral chromatic aberration to shift lightcorresponding to a color component of the image.

In some embodiments, the local processing module (70) may includeinstructions to vary the intensity of a color component based onchromatic aberrations. For example, an image may comprise a first colorcomponent corresponding to a first focal depth and a second colorcomponent corresponding to a second focal depth, the second focal depthmay correspond to the retina of the eye (e.g., the focal point of theeye). The intensity projected by light source (18) of the first colorcomponent may be altered relative to the second color component toreduce the effects of chromatic aberrations. Thus, the un-aberratedsecond color component may be made to appear more dominate relative tothe first color component that contributes to impaired vision. Forexample, if the eye of the user causes red color components to focusbehind the retina (e.g., focal plane of the eye), the user may perceivesa bigger area of red than intended. In response, the ophthalmic devicemay reduce the intensity of the red component to improve vision quality.In another implementation, if a blue component is focused or convergesin front of the retina, then the user perceives less blue than intended.In response, the ophthalmic device may increase the intensity of theblue component to compensate for chromatic aberrations.

In some embodiments, the ophthalmic system may be an augmented realitysystem that corrects for chromatic aberrations. As described above, theophthalmic system may be an augmented reality head mounted displaysystem configured to provide wavefront correction to ambient light fromthe world in front of the user, as well as providing wavefrontcorrection to AR image content displayed by the ophthalmic system. Thesystem, as discussed above, may comprise an outward facing camera.Images from the outward facingcamera can be re-rendered on the displayfor the users viewing. The techniques described above for correcting forchromatic aberration may be applied to these images projected into theeye. Similarly, the AR head mounted display may also compensate forchromatic aberrations of other image content that is also displayed bythe ophthalmic system and projected to the user. Image content from theoutward facingcamera can be combined with other image content andprojected into the eye of the viewer. The head mounted display may beconfigured to compensate for chromatic aberrations in any projectedimage in a manner as described above.

Similarly, the ophthalmic system may be a VR head mounted display systemconfigured to produce VR image content compensating for chromaticaberrations. The VR image content may be generated by the ophthalmicsystem and provided to the user while the user's eyes are covered fromambient light in front of the user by the VR head mounted display system(e.g., opaque). As described above, a VR head mounted display system mayinclude outward facing cameras (e.g., cameras (16)) configured tocapture ambient light from the world in front of the user and generateimages based on the ambient light. The VR head mounted display may beconfigured to compensate for chromatic aberrations in any projectedimage in a manner that is substantially similar to that described above.

In some embodiments, process flow 1000 of FIG. 10A may be implemented tocompensate for chromatic aberrations. In some embodiments, process flow1000 may be performed by patient-worn ophthalmic devices, such as thosedescribed in connection with FIGS. 3A-3D. The process flow 1000 can beimplemented by the local processing module (70), for example, by theremote processing module (72) executed by logic devices in the localprocessing module (70) operably connected to the remote data repository(74). Adaptive optics such as electrically reconfigurable lenses such aslenses located as shown in FIGS. 10B-10E may be used to providerefractive correction based on the user's optical prescription.

At 1002, the ophthalmic system determines an optical prescription, e.g.,the chromatic aberrations due to irregularly shaped optical surfaces inthe eye (e.g., shape irregularities in the cornea, crystalline lens,and/or iris of the eye). The optical prescription may comprise aprescription for longitudinal chromatic aberrations and/or lateralchromatic aberrations. As described above, the ophthalmic device mayinclude a user interface whereby the user inputs an optical prescriptionor the ophthalmic system may go through an eye-prescription configuratorprogram to determine chromatic aberrations of the eye. In someembodiments, as described herein, the ophthalmic system may beconfigured to objectively monitor and dynamically (e.g., in real-time)the user's optical prescription based on inputs received from thebiofeedback system.

For example, the ophthalmic device may be pre-programmed with discretegranular steps in adjusting focus or altering wavefronts, or varying theangle of incidence of an eye-exam image presented to the user by theophthalmic system through the display device (62). The eye-exam imagemay be any image, including conventional eye examination templates,including letters, numbers, graphics, pictures, drawings, designs, etc.In some embodiments, the eye-exam image may include a plurality of colorcomponents. In other embodiments, the eye-exam image may bemonochromatic comprising a single color component. Adjusting the focusmay include adjusting the focus of one or more color components of animage. The user may then specify a desired correction, which may definean optical prescription, to the ophthalmic system through an appropriatefeedback mechanism (e.g., a user interface). Or, in another embodiment,the user may have the option of incrementally increasing or decreasing aprescription (e.g., changing the focus and/or wavefront) until the userarrives at a comfortable viewing prescription. See, for example, thedescription herein connection with phoropter technology. In someembodiments, the ophthalmic system may automatically incrementallyincrease or decrease a prescription based on the user input into thefeedback mechanism.

The ophthalmic system may be configured to present a first monochromaticimage of a first color component. The system may then incrementallychange the focus depth of the first color component. The user may inputinto the user interface or feedback component whether the viewing of thefirst monochromatic image has improved or not through each incrementalchange, and then, after receiving said input, the ophthalmic systemautomatically change the focus of the first color component to the nextfocal depth for user input. Once the system has determined the desiredfocal depth of the first color component, the ophthalmic system may thenrepeat the process for one or more other color components. In someembodiments, the color components are red, green, and blue. Once theophthalmic system performs the eye-exam for each color component, theophthalmic system may define an optical prescription for longitudinalchromatic aberration.

The ophthalmic system may be configured to follow a similar procedure todetermine a lateral chromatic aberration prescription. For example, thefocus point of the first monochromatic image may be incrementallyshifted (e.g., laterally or radially) about the focal plane, eitherautomatically or by user input, to determine a preferred viewingposition of the user. For example, the focus point of the firstmonochromatic image may be shifted about the retina with respect to thefovea of the eye. In particular, the angle at which the beam is incidenton the eye may be adjusted to account for the lateral chromatic image.In some embodiments, the incident beam may be substantially collimated.The offset of the angle may be different for different locations on theimage. The process may be carried out for each color component and theinputs from the user or as objectively determined by the ophthalmicsystem may be stored, thereby defining a lateral chromatic aberrationprescription.

In some embodiments, at 1002, the ophthalmic system may be configured toassess whether the user can view an image comfortably and increase ordecrease the prescription based thereon. In some embodiments, theophthalmic system may utilize a biofeedback system configured toobjectively monitor, in real-time, whether the user can view an imagecomfortably, and increase or decrease the prescription based on themonitoring. For example, the ophthalmic system may include aneye-tracking system to monitor for changes in eye position, movement ofan eye, fluctuations in accommodation, or changes in vergence of theeyes, pupil size, as described herein. Similarly, sensor assembly (39)may be utilized to monitor head position. Changes in head position, eyeposition and/or movement of the eye may be indicative that the user isnot able to comfortably move the image. For example, the image may beblurry and the user may be searching for a comfortable viewing angle orposition. Thus, the ophthalmic system may determine the user is able toview the image of a color component comfortably, and if not,automatically and incrementally adjust (e.g., increase or decrease) theprescription of the user.

Another method to determine whether correction and/or the image is infocus is using an autorefractor. Autorefractor systems for theophthalmic devices similar to those describe herein can be used toassess the level refractive error and focus. For example the ophthalmicsystem may independently project one or more color components of lightinto the eye. The system, through inward facing cameras, may determinethat if the image is focused on the fovea of the retina, then that colorcomponent is in focus. If the color component is not in focus, then theophthalmic system may adjust the prescription to bring the colorcomponent in focus on the fovea. Other methods for objectivelydetermining a prescription includes objectively measuring someone'srefractive error through, for example, phoropter, SLO, autorefractor,etc. as described herein. These technologies may be included as part ofthe biofeedback system configured to, in real-time, evaluate and adjusta user's prescription.

In some embodiments, the ophthalmic system may be configured to receivean optical prescription from a third party. For example, a doctor may beable to send a user optical prescription wirelessly (e.g., over theinternet, Bluetooth connection, etc.), which is received by a receiveror transceiver and stored in the digital memory of the local processingmodule (72).

At 1004, the ophthalmic system retrieves a mapping table to determine anappropriate image modification program to compensate for chromaticaberrations. The mapping and image modification program may be similarto that described above for correcting for myopia, hyperopia, andastigmatism. In various embodiments, the mapping may associate anoptical prescription with image modification programs definingparameters for driving or encoding the optics of the ophthalmic systemto compensate for chromatic aberrations. In another embodiment, themapping may associate an optical prescription with an image modificationprogram defining modifications to be applied by the local processingmodule (70) to an image stored in the digital memory, for example, bysoftware modification. Accordingly, a given prescription may be mappedor associated with a given image modification program to compensate forsaid prescription.

For example, as described above, the longitudinal chromatic aberrationprescription may be associated with an image modification programcomprising parameters to drive the waveguide stack. The parameters maydefine waveguides and/or reconfigurable elements, for example, dynamiclenses associated with the waveguides based on the desired the opticalpower or wavefront curvature to be applied by a given waveguide to anincident wavefront of a color component, so as to compensate for thechromatic aberrations. In such an embodiment, the parameters mayselectively address specific dynamic lenses at each waveguide tocompensate for the aberrations, as described above.

In another embodiment, the image modification program may includeparameters to be applied to the adaptable optics or VFE of theophthalmic system based on the desired compensating wavefront. Theparameters may define the modifications to be applied to the shapeand/or characteristics of the adaptable optics, thereby altering thewavefront to compensate for chromatic aberrations. These parameters maycorrespond to a set of signals that may be based on the opticalprescription. For example, the image modification program may have a setof parameters configured to encode a compensating wavefront curvatureinto the optics of the ophthalmic system (e.g., the VFE or adaptableoptics of display device (62)). The compensating wavefront curvature maybe such that the wavefront of an image that reaches the retina of theeye is corrected to account for chromatic aberrations in the shape ofthe optical surfaces of the eye and/or optical system of the ophthalmicsystem, thereby reducing chromatic aberrations.

In yet another embodiment, the image modification program may defineparameters for modifying a 2D image of generated by the ophthalmicsystem to compensate for chromatic aberrations, as described above. Forexample, for a given optical prescription, the parameters may define anincrease or decrease in intensity to be applied to one or more colorcomponents to reduce the effects of chromatic aberrations (e.g., fringediscoloration). The intensity may be defined in luma and may be in partbased on the color component and the focal depth of an uncompensatedcolor component, as described above.

While some exemplary embodiments are described above, it will beunderstood that other configurations for compensating for chromaticaberrations are possible, and that other methods and approachesdescribed throughout this disclosure may be utilized to compensate forchromatic aberrations.

In some embodiments, the remaining steps of process flow 1000 may becarried out in a manner similar to that described above for correctingfor myopia, hyperopia, and astigmatism. Thus, at 1006, the ophthalmicsystem selects the appropriate image modification program to apply tothe images projected to the user by the display of the ophthalmicdevice. For example, the ophthalmic system may select an imagemodification program based on the association of the opticalprescription and the desired compensating image modification program. Inthis embodiment, the image modification program may change the focaldepth of one or more color components of an image to compensate forlongitudinal chromatic aberrations. In another embodiment, alternativelyor in combination, the image modification program may change the angleat which light of one or more color components of an image is projectedto compensate for lateral chromatic aberrations.

At 1008, the ophthalmic system may apply the image modification programto compensate for chromatic aberrations of the projected images.

At 1010, the ophthalmic system may project the corrected wavefront ofthe image to the user through the display of the ophthalmic system. Forexample, the ophthalmic system may compensate for chromatic aberrationsby modifying the wavefront to be presented to the user by the ophthalmicsystem. As described above, in one embodiment, the ophthalmic system mayvary the focal depth of one or more color components of the incidentwavefront to generate a compensating wavefront. Similarly, theophthalmic system may produce a shifted image for one or more a colorcomponents based on a varied angle of incidence for that color componentto compensate for lateral chromatic aberrations. In either case, theimage content may be obtained by front facing cameras (e.g., cameras(16)), which may be included in both an augmented reality head mounteddisplay system or a virtual reality head mounted display system. Theimage content can also be form other source and comprise other content.

In various embodiments, the ophthalmic system may automatically applythe chromatic aberration compensation to an incident wavefront based oninformation stored remotely (e.g., external to the ophthalmic device),for example, at remote data repository (74). As described above, thecorrected wavefront may be projected to the eye of the user by theophthalmic system via display device (62) combined or superimposed ontothe image on which the corrected wavefront is based.

In various embodiments, the process flow 1000 may be implemented as adynamic vision correction system as described above. For example, theadaptable optics can be driven by electrical signals that change theshape and/or characteristics of the adaptable optics. The alteredcharacteristics of the adaptable optics may then change the shape of awavefront incident on the adaptable optics to produce a compensatingwavefront. This wavefront compensation by the ophthalmic system may bechanged in real-time as the optical prescription of the user changesover time. For example, the chromatic aberration errors of a user's eyemay change as the user ages. In some embodiments, at 1010 the ophthalmicsystem may implement dynamic vision correction by initiating aneye-prescription configurator program. At 1010, the ophthalmic systemmay be configured to return to 1002 and manually and interactively (orautomatically) determine the user's prescription at various points overtime, in some embodiments, with or without user initiation, for exampleat 1002 of FIG. 10A. Thus, the ophthalmic system may dynamicallyidentify a first optical prescription at a first time and adjust thecorrection for refractive defects based on that prescription, andidentify a second optical prescription at a second time and adjust thecorrection for refractive defects based on that second prescription. Thehistorical data regarding the different correction over time can also bestore and used to determine if the user has a health condition orabnormality.

Phoropter

Referring now to FIG. 14, in one or more embodiments, a wearableaugmented reality device 1400 can be used as an ophthalmic system tofunction as a phoropter or refractor to determine a suitable refractionthat corrects or improves the vision of a wearer or a patient. Theresults of this test can be used, for example, to determine a wearer'sor patient's optical prescription (e.g., for corrective lenses inglasses or contact lenses or for use in an augmented reality device). Itshould be appreciated that such a system may be used to administer aneye exam, and this exam may typically be administered at a doctor's orclinician's office. In one or more embodiments, the patient's individualophthalmic system may be used, possibly with doctor supervision, or thedoctor's office may have its own version of the ophthalmic system thatmay be used for diagnostic purposes. Although FIG. 14 is discussed inconnection with augmented reality, similar features can be included in avirtual reality device such as virtual reality eyewear as well.

A typical phoropter is used by eye care professionals for eyeexamination and to determine a patient's refractive error and thereforecorrective refractions to compensate for any ocular anomalies. Usingthis information, the eye care professional can determine an opticalprescription of the patient's eyes to improve or correct the patient'svision. The phoropter typically comprises different lenses that may betested, and usually involves presenting an eye test chart of alphabetsof varying sizes to test the patient's vision. The patient looks at theeye test chart and lenses of different refractive powers are placed infront of the patient's eyes to determine whether the patient's visionhas improved. The traditional set up tends to be bulky, and requires thedoctor to individually select a next step size in the lens. Theclinician typically asks the patient's feedback on image clarity, andchanges the lenses accordingly.

In contrast, some embodiments of the wearable augmented (or virtual)reality device 1400 may be used to perform much of these same functionswithout a bulky phoropter setup. The wearable augmented (or virtual)reality device 1400 includes an augmented (or virtual) reality displayplatform 1402 configured to project an image to the eye of a wearer. Thedisplay platform 1402 can be configured similarly to the display lens106, as described herein, for example, with reference to FIG. 5. In someimplementations, such as for augmented reality devices, the displayplatform 1402 can also be configured to pass light from the world orenvironment through the display platform 1402 (e.g., through a lens inthe front thereof) to the eye of the wearer. In this way, the wearer cansee images projected with the display platform 1402 superimposed withwhat the wearer can see in the world. In some embodiments, rather than aphysical eye test chart, a virtual eye test chart 1420 may be projectedto the wearer using the display platform 1402. To provide functionalitysimilar to a phoropter, the focus of the image can be varied. Thewearable augmented (or virtual) reality device 1400 can be configured toadminister or provide an eye exam by automatically providing incrementalchanges in an optical prescription by varying the focus of the image.Similarly, an eye exam can be administered by varying the refractivepower of adaptive optics elements in the display platform 1402.

As described herein, the augmented reality device 1400 can includeadaptive optics that are configured to change their optical properties.The adaptive optics or variable focus elements (VFE) can provide avariable optical correction, such as sphere, cylinder and axis, orhigher order aberration correction. The adaptive optics elements caninclude deformable mirrors that are configured to change the shape ofthe reflective surface to direct light to targeted locations. Theadaptive optics elements can include optics configured to change anindex of refraction to selectively direct light to targeted locations(e.g., liquid crystals). The adaptive optics can include one or morelight modulators configured to selectively direct light using aplurality of pixels. The adaptive optics can include acousto-opticmodulated mirrors that are configured to time-multiplex incident lightto selectively direct incident light.

In certain implementations, the display platform 1402 includes aplurality of waveguides. The plurality of waveguides can be structuredin a parallel or in a serial fashion. The waveguides can be configuredto project and receive light. The received light can be imaged orotherwise detected. This may be utilized in an eye exam where thewaveguides are configured to image the retina of the wearer to monitorimages formed at the retina. Individual waveguides can correspond todifferent depth planes. To determine the accommodative state of the eye,a reflex from the retina (e.g., the reflex from an image projected intothe eye of the wearer) can be measured using the waveguides. This canresult in a rapid measurement of the accommodative state of the eye. Forexample, a sequence of point source images (e.g., outside of the visiblewavelength band) can be projected from various depths from thewaveguides into the eye of the wearer and the waveguides cansimultaneously measure the reflex from the retina. The augmented (orvirtual) reality device 1400 can be configured to determine in real timethe accommodative state of the eye by determining which depth planecorresponds to the brightest, smallest, or best focused image based onthe reflex that is the most collimated. In effect, the waveguide stackcan act as a set of tuned autocollimators with each waveguidecorresponding to a particular focal and/or accommodative state. To doso, the augmented (or virtual) reality device 1400 can be configured toproject a beam of light from an optical source into the eyes of thewearer. A portion of the projected beam can be reflected, scattered,and/or diffracted by various anatomical features of the eye of thewearer and received by one or more imaging devices. An electronichardware processor can be used to analyze light received from the eye ofthe wearer to examine the various structures of the wearer's eye. Thiscan result in a determination or approximation of the accommodativestate of the eye, which may include the shape of the lens, the pupilconstriction state, the vergence, dynamic accommodation, etc.

In some embodiments, refractive correction can be provided by theaugmented or virtual reality device 1400 using adaptive optics whereinlight is injected into waveguides using deformable mirrors and/orrefractive lenses. Refractive correction can also be provided using aspatial light modulator (e.g., an optical component comprising an arrayof elements configured to change a phase of incident light). In certainembodiments, refractive correction can be provided using light from afiber or other light source such as a scanning source (e.g., a fiberscanning device) that is directed to a deformable mirror that couplesthe light into a free-space optical beamsplitter to selectively directlight to targeted locations. By altering the shape, refractive index, orphase of the adaptable optical element, properties of wavefront, such asthe phase projected by the augmented reality device 1400 can be alteredto provide refractive correction designed to reduce or compensate forthe refractive error of the wearer's eye.

In some embodiments, an adaptive optical modulated mirror can beconfigured to selectively direct light into one of a plurality ofwaveguides. Each of the waveguides can include optical elements (e.g.,lenses, mirrors, etc.) configurable to provide a particular opticalpower. For example, an augmented reality or virtual reality device 1400can include 10 waveguide stacks where each stack can apply about 0.5Doptical power. By selectively directing light into one of the waveguidesand turning the light through a plurality of other waveguides, subsetsof the waveguides and associated optical power can be provided to thewavefront. A targeted refractive power/correction (e.g., of sphere) maybe achieved. In some embodiments, the waveguide stacks are used inconjunction with adaptive optics elements to correct for astigmatismand/or higher order optical aberrations.

In some embodiments, the augmented reality device 1400 uses pureadaptive optics to achieve a refractive correction. For example, theaugmented reality device 1400 can include a plurality of lenses andmirrors. For example, an adaptive optical lens that is transmissive canbe employed to correct light projected by a light source of the displayas well as correct ambient light form the world in front of the eyewear.In some such embodiments, a plurality of waveguides need not be employedas adaptive optical elements but can be time-multiplexed to enablescanning of different colors (e.g., red, green, and blue) as well asdepth planes. In certain implementations, the colors can be scanned foran individual depth plane prior to proceeding to the next depth plane.In some embodiments, a beamsplitter may be employed to couple in lightfrom the light source although other configurations are possible. Insome embodiment, a plurality of light guides may be included with theadaptive optical lens. Multiple colors or depth planes can be scannedsimultaneously in some embodiments. Transmissive spatial lightmodulators that modulate the phase may also be used to alter thewavefront shape and provide refractive correction. Adaptive opticalmirrors may also be employed. In some embodiments, reflectors may beused to tailor the optical path as desired. A beamsplitter may also beemployed, in certain embodiments, to couple in light from the lightsource.

In some implementations, to conduct an eye exam, the user/wearer may bepresented with a variety of images of varying sizes, and the user/wearermay provide input as to the clarity of the image through a userinterface 1404 of the ophthalmic system. In some embodiments, theophthalmic system is configured to automatically determine the clarityof the image based at least in part on detecting whether the image isfocused on the retina of the wearer. This can be done by imaging theretina of the user and measuring, analyzing, and/or observing the reflexfrom the retina of the projected image. Rather than physically changinglenses, as in a typical phoropter, if the user/wearer indicates that aparticular image is not clear, or that the image is not comfortablyseen, the focus of the image may be automatically varied, (e.g., throughthe VFE or adaptable optics such as discussed herein,) to provideincremental changes in the corresponding or equivalent opticalprescription. Thus, eye exams may be conducted seamlessly through theophthalmic system locally or remotely. For example, a clinician ordoctor can administer the eye exam remotely, such as, by way of exampleand without limitation, over a phone, using video conferencing, over anetworked communication program, or the like. It should also beappreciated that, in some implementations, the eye exams may beconducted with or without direct interaction from a clinician or withless or minimal effort and time of the clinician.

In some embodiments, adjustments to the optical prescription may beautomatically performed by the ophthalmic system based on physicalchanges of the eye while attempting accommodation and/or vergence. Forexample, the ophthalmic system may be programmed to detect certainpatterns of eye behavior that are symptomatic of weakening eyes. Basedat least in part on the tracked eye behavior, eye adjustments may beautomatically made by the ophthalmic system. The system may for example,upon detecting that the wearer struggles to accommodate, initiate aphoropter examination such as described herein or the system may alertthe wearer or clinician that the wearer is struggling to accommodate. Insome embodiments, the system detects that the wearer struggles toaccommodate by detecting microfluctuations in accommodation (e.g., smalland/or rapid changes in lens shape, vergence, pupil size, etc.). Incertain implementations, accommodative struggles can be detected bymonitoring the focus state of an image projected onto the retina of thewearer, as described herein. If the reflex from the retina isfluctuating, the system can be configured to determine that the weareris struggling to accommodate. The system might present the wearer withimages, and test different optical corrections asking the users toprovide feedback as to whether the optical correction improves theimages. In some implementations, rather than asking for the wearers toprovide feedback, or in addition to asking for feedback, the system canbe configured to determine if the image is in focus by observing,measuring, and/or analyzing the image on the retina of the wearer. Asdiscussed above, adaptive optics or one or more VFE may be used toimplement the different test corrections during the examination. In someembodiments, the system can be used to determine a phoria of the wearerby presenting images to eyes of the wearer one eye at a time. In certainimplementations, the system can be used to monitor vergence of thewearer on a target. If the wearer is exophoric when attempting to focuson a close image (e.g., an image projected from a near depth plane), thesystem can be configured to determine that the wearer may be presbyoticor fatigued and/or whether the wearer may have strabismus or amblyopia.The system can also be configured to administer a variety of tests ofvisual field by providing images from a variety of different depthplanes.

In some embodiments, the display platform 1402 includes a fiber scanningdevice, such as, for example, discussed herein. In various embodiments,the fiber scanning device can be configured to provide different depthplanes from which the image or portions of the image can be projected.In some embodiments, the display platform 1402 includes a waveguidestack, as described herein. The waveguide stack can be configured toprovide different depth planes from which the image or portions of theimage can be projected. In certain implementations, the waveguide stackincludes one or more lenses in the stack, as described herein. In someembodiments, the display platform 1402 includes adaptable opticselements configured to project light with different focal planes. Incertain implementations, the adaptable optics elements include variablefocus elements (VFEs), as described herein. In some embodiments, thedevice 1400 can be configured to vary the focus of the projected imageby changing an optical path of one or more elements of the displayplatform 1402. In certain implementations, the device 1400 is configuredto vary the optical path length through the use of a fiber light source.For example, the fiber light source can be configured to vary the focus(e.g., the focal point) of the projected image by varying the fiberlength (e.g., transmitting light from fibers of different lengths)and/or position (e.g., by mechanically moving a fiber). In certainimplementations, the device 1400 is configured to vary the focus of theprojected image by varying a microelectromechanical system (MEMS). Forexample, the device 1400 can include micro-optics implemented using MEMSthat include diffractive, refractive, and/or reflective optics elementsthat can be used to vary the focus of the image. Other types of variablefocus elements or adaptive optical elements may be employed.

The image provided by the ophthalmic system can be a stored image. Thewearable augmented (or virtual) reality device 1400 can include a datastore that includes one or more stored images suitable for conducting aneye exam or for determining an optical prescription for a wearer. Thestored image may be letters, number, symbols etc. such as used in eyecharts. The image may be presented to the viewer at the desired depthplane, such as at infinity or an otherwise large distance, e.g., atleast 20, 40, 60, 80, or 100 feet away. As described herein, the storedimage can be processed to produce corrected wavefronts for projecting tothe wearer. The corrected wavefronts can be configured to account for anoptical prescription or anomaly of the wearer's eye. In someembodiments, adaptable optics in the display platform are used toprovide adjustments to the image that the wearer sees to account for theoptical prescription. In certain implementations, a combination ofadaptable optics and/or software is used to provide the appropriateoptical correction to adjust projected images to account for anomaliesin the wearer's eye(s). The software may, for example, alter theintensity pattern comprising the image, for example, to compensate fordistortion or fisheye wherein straight lines appear curved. For example,to compensate for pincushion distortion, some barrel distortion may beintroduced into the intensity pattern that comprises the images.Similarly, to compensate for barrel distortion, some pin cushiondistortion may be introduced into the intensity pattern that comprisesthe images. Other types of modifications to the intensity pattern thatmakes up the image may be introduced by software that is used to drive aspatial light modulator or light source to produce the desired intensitypattern. In some embodiment, the wearable augmented or virtual realitydevice 1400 can be configured to use the display platform 1402 toproject images of varying size to the wearer or images from varyingdepth planes to the wearer. In some implementations, the image caninclude letters or shapes of varying sizes and/or projected from varyingdepth planes. In various implementations, the size and/or depth planesof the letters and/or shapes projected to the wearer can be variedduring the eye exam. In some embodiments, the system can be configuredto administer a brightness or glare test that include objectivemeasurements of functional visual acuity in different brightness andglare conditions. In various embodiments, the system can be configuredto administer a brightness acuity test to determine the functionalvisual acuity in various bright light conditions. For example, thesystem can be configured to simulate three or more bright-lightconditions: 1) high-direct overhead sunlight; 2) medium-partly cloudyday; and 3) low-bright overhead commercial lighting. The visual acuitymeasurements can be similar to those that would be measured in thesethree conditions using a standard eye chart (e.g, the eye chart 1420).The result of such a test may be an assessment of functional visualacuity. Such tests can be used to test for sensitivity to bright light,photophobia, impaired scotopic vision, and the like. In someembodiments, the system can be configured to test individual colors. Forexample, the ophthalmic system can be configured to determine refractiveerrors for individual colors (e.g., red, green, blue, yellow, etc.). Insome embodiments, the system can be configured to test a variety ofdepth planes. For example, the ophthalmic system can be configured todetermine refractive errors for individual depth planes. This can resultin an optical prescription that changes based at least in part on depthplane. Refractive correction for presbyopia may also be determined.

In some embodiments, the wearable augmented (or virtual reality) device1400 can include one or more outward facing cameras. In certainimplementations, the one or more outward facing cameras can be similarto the cameras 16 described herein with reference to FIG. 5. The outwardfacing cameras in an augmented reality display device can be configuredto capture images the surrounding environment to determine, for example,where to superimpose a test image such as letters or symbols. Forexample, the augmented reality device might superimpose an image of aneye chart, such as a standard Snellen chart or other visual acuity chartover an area in the field of view of the wearer corresponding to thewall of the optometrist's office. In another example, the outward facingcameras can be configured to capture images of an eye chart, such as astandard Snellen chart or other visual acuity chart that is actually onthe wall of the optometrist's office. The wearable augmented or virtualreality device 1400 can then be configured to modify the captured imagebased at least in part on the desired depth plane for presenting theimage. For example, the acquired image can be projected by the displayplatform 1402 at infinite accommodation. Then, through a user interface1404, the light from image can be manipulated to provide functionalitysimilar to changing a lens with a typical phoropter. For example,sphere, cylinder, or higher order aberration correction can beintroduced. If cylinder is to be added, the appropriate axis can also bedetermined. In this way, an eye exam can be conducted to determine anoptical prescription of the wearer. In some embodiments, the system isconfigured to objectively measure or estimate an optical prescriptionthrough observation, measurement, and/or analysis of the manipulatedimage, determining whether it is in focus on the retina of the wearer,as described elsewhere herein.

The wearable augmented reality device 1400 can include one or more userinterface features 1404 configured to allow a wearer or other person toprovide input to the device. The user interface features 1404 can beintegrated with the device 1400, as illustrated in FIG. 14. In someimplementations, the user interface features 1404 are provided by adevice or component that is not physically integrated with the device1400. For example, the user interface features 1404 can be provided by adevice or system that is in communication with the device 1400. This canbe a smartphone, computer, tablet, or other computational device that isin wired or wireless communication with the device 1400. In someembodiments, the user interface features 1404 can be provided by acombination of different devices and systems linked to the device, e.g.,through wired or wireless communication networks or through componentsthat are physically linked to the device or integrated with the device.A touch screen, voice recognition system, or virtual touch screen aresome examples of interfaces. Accordingly, the user interface features1404 can include capacitive features sensitive to touch, keyboards,buttons, microphones, photodetectors, cameras, and/or a variety ofsoftware-implemented features provided by a graphical user interface.The user interface features 1404 can be presented on a device with atouch screen wherein interaction with the touch screen provides input tothe wearable augmented or virtual reality device 1400. In variousembodiments, a virtual touch screen is provided through the imagesprojected to the users eyes and sensors to sense the users moving body,e.g., finger. In some embodiments, the user interface features 1404include gesture detection components to allow a wearer to provide userinput through gestures. In some embodiments, the user interface features1404 include gaze detection components to allow a wearer to provide userinput through gaze of the eyes (e.g., this can include selecting abutton or other element when the wearer fixates on the button for a timeor when the wearer blinks when fixated on the button). Such userinterface systems can be employed for other devices and systemsdescribed herein.

In the ophthalmic system, the user interface features 1404 can be usedby the wearer to provide feedback regarding the quality of the image asperceived by the wearer. The wearer can provide feedback through theuser interface features 1404 regarding whether the wearer cancomfortably view the image being projected to the user for example aschanges to the applied refractive power (e.g., incremental values ofsphere, cylinder, and axis and/or higher order aberration correction)are provided incrementally. In this manner, an appropriate opticalprescription for the wearer can be determined.

In some implementations, the clinician or doctor can also use theinterface features 1404 to vary the focus and/or the depth plane fromwhich the image is being projected to the wearer or the size of theimage being projected. Such changes can be used to incrementally ifdesired.

FIG. 15 illustrates an example method 1500 for determining an opticalprescription of a wearer of an augmented (or virtual) reality deviceconfigured for use as a virtual phoropter. For ease of description, themethod 1500 will be described as being performed by an ophthalmicsystem, such as the augmented (or virtual) device 1400 described hereinwith reference to FIG. 14. However, it is to be understood that anycomponent or subpart of the various augmented reality (or virtual)devices disclosed herein or other similar devices can be used to performany step, combination of steps, or portions of a step in the method1500.

At block 1502, the ophthalmic device initiates an eye test program. Theeye test program can be a stored process or sequence of functionsprovided by the ophthalmic device. Initiating the eye test program caninclude determining or retrieving a starting optical prescription, suchas for a wearer that has previously undergone an eye test or other eyeexam. In some implementations, the eye test program can integrateinformation about ocular anomalies of the wearer's eye(s), where theinformation about the ocular anomalies can be entered by the wearer orclinician, determined from a previous eye test program, or retrievedfrom a data store (e.g., a data store that is part of the ophthalmicsystem or a networked data store). Initiating the eye test program caninclude determining the image or sequences of potential images to beprojected to the wearer. Initiating the eye test program can includedetermining whether a clinician or doctor is administering the eye examor whether the examination is being self-administered by the wearer. Insome embodiments, the ophthalmic device initiates the eye test programin response to input received from the wearer or a clinician.

At block 1504, the ophthalmic system projects an image to the wearer'seyes. For example, the ophthalmic system can project an alphabet,letters, and/or shapes of a targeted size to the wearer. The image canbe a stored image or the image can be acquired by the ophthalmic system.The image can include elements configured to aid in determining visualacuity of the wearer, wherein the visual acuity elements comprise, forexample and without limitation, icons, symbols, letters, shapes, or thelike. The visual acuity elements of the image can have a variety ofsizes within the image and/or the size of the visual acuity elements canbe varied by the ophthalmic system.

At block 1506, the ophthalmic system receives user input regarding theimage. The user input may indicate whether the wearer is able to viewthe image clearly or not. In one or more embodiments, the ophthalmicsystem may begin by projecting relatively small letters that increase insize until the received user input indicates that the wearer can see theprojected image clearly. In some embodiments, the ophthalmic system isconfigured to present an eye chart, such as a conventional eye chartlike the Snellen chart. In such embodiments, the received user input caninclude which portion or portions of the projected chart the wearer cansee clearly.

At block 1508, the ophthalmic system determines whether the user cancomfortably view the image (e.g., a projected eye chart). In someembodiments, the system is configured to receive user input through auser interface as to whether the user can comfortably view the image. Asdescribed above, examples of such a user interface may include a voicerecognition system, a touch screen, or a virtual touch system.

In some embodiments, the user input received in block 1506 isautomatically determined through analysis of physical and/or opticalcharacteristics of the wearer. For example, the user input that isautomatically determined includes analysis of whether the image is infocus by observing, measuring, and/or analyzing the retina of thewearer. As described herein, by measuring the reflex from the retina,the ophthalmic system can be configured to assess the quality or degreeof focus of the image formed by the wearer's eye. In some embodiments,the ophthalmic system can be configured to project a pair of spots intothe eye of the wearer. The reflex of these projected spots can bemeasured and analyze to determine the quality of focus of the image. Forexample, where the images of the projected spots on the retina arealigned, the ophthalmic system may determine that the wearer is focusingon the projected image or that the wearer is accommodating properly atthe targeted location.

In some embodiments, the ophthalmic system is configured to determinethat the wearer can comfortably view the image based at least in part ondetection of relaxed accommodation and/or vergence. As described herein,the ophthalmic system can include eye detection and/or trackingcomponents configured monitor the eye. Such components may be able todetect accommodation, vergence, and/or pupil size of the wearer. Lensaccommodation may be detected, for example, with an OCT (as described ingreater detail elsewhere herein) that images the lens or anautorefractor (as described in greater detail elsewhere herein) thatmeasures a size of an image on the retina. Vergence and pupil size canbe measured with one or more inward facing cameras. In some embodiments,the ophthalmic system monitors the fluctuations of the eye when the useris trying to focus on a targeted object or image. For example, when aneye focuses on a stationary stimulus, the power of the lens of the eyechanges rapidly and continuously. When a person struggles to focus on astationary object, these fluctuations can increase. This increase influctuation can be measured and/or observed by the ophthalmic system todetermine that the wearer is not focusing on the targeted image orobject. In some embodiments, the ophthalmic system can be configured tomonitor these fluctuations and move the projected image (e.g., changethe depth plane from which it is being projected) until the wearersuccessfully focuses on the object. For example, the ophthalmic systemcan project the image from a depth plane that is relatively near thewearer and push the image back (e.g., increase the distance between thewearer and the depth plane) until the ophthalmic system determines thatthe wearer is accurately focusing on the image.

Monitoring of the accommodation reflex of the eye can be employed by theophthalmic system to determine if the wearer is not comfortable with thecurrent prescription or if the wearer needs optical correction. Animaging system such as OCT, which can show the front and rear surfacesof the natural lens of the eye, can be used to determine whether thewearer is accommodating. For close objects, the convexity of the lens isexpected to increase. OCT or other imaging system such as describedherein (e.g., ophthalmoscope, SLO, confocal microscope, etc.) can alsopossibly monitor changes in curvature of the lens surface and/ormovement of the lens or change in the shape of the lens or structuralfeatures of the eye to determine whether a wearer is accommodating,examples of which are described elsewhere herein. Additionally, anautorefractor can be used to determine whether the wearer isaccommodating by monitoring the size of an image projected through thelens onto the retina, examples of which are described elsewhere herein.Such methods of monitoring accommodation can be used to determinewhether the wearer is accommodating, which can be useful in assessingwhether the wearer need optical correction.

Vergence can be employed to assist in determining if an opticalcorrection is needed as well, where vergence is monitored to testaccommodation reflex. Using inward facing cameras and processingelectronics, the ophthalmic system can be configured to track changes inthe line of sight of the left and right eyes and to determine thevergence. Such vergence information can be used to determine whether thewearer's eye is responding as expected to images presented at variousdepth planes. For example, if both eyes are substantially parallel andnot converging when an image at a relatively close depth plane is beingpresented, the ophthalmic system can be configured to interpret thisresult as indicating that the wearer is not seeing the image comfortablyor that the wearer has a vision defect. The vergence for different depthplanes can be determine and whether the eyes match the proper vergencefor a particular depth plane can be assessed. Likewise, potentially ifvergence is observed to be inward for a depth plane that is at infinity,the wearer may need optical correction.

As another example, the ophthalmic system can test accommodation reflexby determining a size of the wearer's pupil or a change in the size ofthe wearer's pupil when an image is projected to the wearer. Theophthalmic system can be configured to track changes in the pupil sizeusing an inwardly facing camera that images the eye and in particularthe iris. This information can be used to determine whether the wearer'seye is responding as expected to images presented at various depthplanes. For example, the size of the pupil is expected to constrict whenlooking at a closer object (compared to an object that is farther away).Thus, the ophthalmic system can be configured to present an image from aclose depth plane and to track the response of the wearer's pupil. Ifthe pupil does not constrict, or constrict sufficiently, the ophthalmicsystem can be configured to interpret this result as indicating that thewearer is not seeing the image comfortably.

Accordingly, to determine the comfort of the wearer in viewing an image,the ophthalmic system can determine the accommodation, vergence, and/orpupil size of a wearer as part of an examination of the accommodationreflex, when a particular image is projected to the user. Similarly, thecomfort of the wearer can be determined when the image is projectedthrough a variety of depth planes. In some embodiments, the ophthalmicsystem can compare the measured accommodation, vergence, and/or pupilsize to an expected accommodation, vergence, and/or pupil size. If oneor more of the measured characteristics are within a targeted range ofthe one or more expected characteristics, then the ophthalmic system candetermine that the wearer is comfortably or correctly seeing the image(e.g., the wearer is seeing the image with expected, adequate, or normalvisual acuity). If one or more of the measured characteristics areoutside of the targeted range of the one or more expectedcharacteristics, then the ophthalmic system can determine that thewearer is not comfortably or correctly seeing the image (e.g., thewearer is seeing the image with impaired visual acuity). In someembodiments, the ophthalmic system combines information regarding themeasured characteristics with the information received or determinedfrom the user input in block 1506 to determine whether the wearercomfortably sees the projected image. For example, when viewing an imagefrom a relatively close depth plane, the wearer's eyes are expected toconverge or move towards one another, the pupils are expected toconstrict, and the convexity of the lens is expected to increase.Deviation from one or more of these expectations can be interpreted asindicating that the user is not seeing the projected image comfortablyor correctly (e.g., the wearer is seeing the image with impaired visualacuity).

If the ophthalmic system determines that the wearer is unable tocomfortably view the image, for example, either by receiving input fromthe user through the user interface or by assessing the user'saccommodation and/or vergence, the ophthalmic system proceeds to block1510 to change the focus to incrementally increase the prescription(e.g., add or subtract more positive or negative sphere to get more amore positive or negative spherical wavefront). The system can also testfor astigmatism and thus incrementally change the axis and cylinder. Theophthalmic system then returns to block 1506 to receive or determineuser input to again determine whether the user can comfortably orcomfortably view the image (e.g., with normal visual acuity). This loopcan be repeated until the user comfortably sees the image.

In some embodiments, the ophthalmic system is configured to adjust theoptical correction at block 1510 based at least in part on feedbackreceived at block 1506 from the user input and/or objective assessmentdetermined at block 1508 or as described elsewhere herein. In someembodiments, the ophthalmic system is configured to adjust the opticalcorrection at block 1510 based at least in part on measurements of theaccommodation, vergence, accommodation reflex, and/or pupil size of thewearer when viewing the projected image. Thus, in certainimplementations, the ophthalmic system can be configured to conduct theeye examination using subjective and objective tests to determine anoptical prescription for the wearer.

In some embodiments, a subjective element of the eye examination caninclude projecting an image and then projecting the image with a diopterchange (e.g., ±0.01D, ±0.1D, ±0.125D, ±0.25D, ±0.5D, ±1.0D, or asubstantially continuous change in diopter power such as through anadaptable optics element, etc.) and receiving user input regardingwhether the image quality changed. In certain implementations, theophthalmic system can also be configured to determine changes in thewearer's eyes (e.g., accommodation, vergence, pupil size, etc.) when thediopter is changed. This objective test data can be combined with thesubjective response of the wearer to determine if the change in diopterresults in a change in visual quality for the wearer.

If the ophthalmic system determines that the wearer is able to view theimage comfortably, the ophthalmic system proceeds to block 1512 todetermine the prescription of the wearer's eyes. It should beappreciated that, in some implementations, the same process may berepeated for both eyes (e.g., both eyes can be treated together applyingthe same correction to each eye or individually applying differentcorrection to the left and right eyes). In some embodiments, this can beused to treat anisometropia where two different optical prescriptionsare applied to the respective two eyes of the wearer. In someembodiments, the ophthalmic system can be configured to dynamicallyswitch between optical prescriptions depending on what is being viewedby the wearer and/or what activities are being performed by the wearer.For example, lenses for anisometropia can be fatiguing for a wearer whenprimarily viewing images that are near or that are primarily far whencompared to when a wearer is viewing images that are a mix of near, mid,and far ranges. Accordingly, the ophthalmic system can be configured todynamically change the optical prescription applied in real time basedat least in part on known optical prescriptions for treating a wearer'sanisometropia, myopia, or hyperopia.

The method 1500 can be used to provide information to an augmented (orvirtual) reality device, such as the device 1400 described herein withreference to FIG. 14 or other similar devices described herein. Thus,the augmented (or virtual) reality device can be configured to changethe focus or other aspects of images being projected based on theoptical prescription of the wearer as described herein. In someembodiments, the same wearable augmented (or virtual) reality devicethat the wearer uses for entertainment, work, or other purposes can beused to perform the eye examinations described herein.

The method 1500 can be used to determine optical prescriptions, opticalcorrection, or refractive correction for different depths. For example,there can be a first optical prescription for a far depth plane, asecond optical prescription for a mid-depth (intermediate) plane, and athird optical prescription for a near depth plane or far and near, farand intermediate, near and intermediate.

The method 1500 and system can be used to correct or improve a wearer'svision where the wearer suffers from presbyopia. Different opticalcorrections can be applied to different depth planes and the associatedcontent projected from those depth planes. Or the wearable augmentedreality devices can be configured to switch between providing theprescriptions for far distance (if any) and near distance based on thesensed orientation of the users, e.g., the user's head or eye. Asdescribed herein, orientation sensors or other sensors can be used todetermine the orientation of the user's head or eye.

The method 1500 can be performed in real time to automatically determinean optical prescription of a wearer. This information can be stored inthe ophthalmic system and used for future tests. For example, theophthalmic system can be configured to update the wearer's currentoptical prescription for the wearer based on the examinations. Forexample, the ophthalmic system can be configured to monitor the eye andrecord the eye behavior of the wearer over time. Based at least in parton this information, the ophthalmic system can dynamically adjust theoptical prescription of the wearer over time. For example, theophthalmic system can measure the behavior of the eye when presenting animage at a known depth. The ophthalmic system can determine deviationfrom the expected eye response to the image to determine if the eye isbehaving as expected. The ophthalmic system can be configured toinitiate an examination and/or update the wearer's optical prescriptionor to initiate or schedule an updated eye examination if the ophthalmicsystem determines that the determined deviation is outside of a range,e.g., targeted, acceptable range of the expected behavior.

In some embodiments, the ophthalmic system can be configured todetermine the optical prescription obtrusively. For example, this mayoccur where the ophthalmic system does not provide alternativefunctionality to the wearer while the eye examination is beingconducted. In other words, this may occur where the wearer is requestedto focus solely on the eye examination.

In some embodiments, the ophthalmic system can be configured todetermine the optical prescription unobtrusively. For example, this mayoccur where the ophthalmic system is configured to acquire measurementsof the wearer's eye behavior while the wearer is doing other things(e.g., watching movies, reading text, looking at images, etc.). Theophthalmic system can be configured to measure characteristics of thewearer's eyes while the wearer is performing these other activities, tocompare measured characteristics of the wearer's eyes, to determinedeviations from expected characteristics of the wearer's eyes. In someembodiments, the system can be configured to determine the opticalprescription based at least in part on these determined deviations. Insome embodiments the expected characteristics of the wearer's eyes canbe based at least in part on the depth planes and image properties beingprojected to the wearer. In some embodiments, when such deviations aredetected, the system could ask the user to undergo an examinationapplied by the system or confirm a test optical correction as sufficientor insufficient. In some implementations, the ophthalmic system can beconfigured to track physical changes in the wearer's eyes whileattempting accommodation and vergence while performing these otheractivities. In some embodiments, this information can be compared tomeasurements acquired while not attempting accommodation and vergence todetermine the optical prescription.

In some embodiments, the ophthalmic system can be configured toobjectively measure an optical prescription of a wearer. In variousimplementations, this may be accomplished without receiving feedbackfrom the wearer regarding image quality. In certain implementations,this may be accomplished without projecting images of varying sizes tothe user. For example, the ophthalmic system can be configured toproject an image from a virtual infinite depth (e.g., the ophthalmicsystem puts the image at infinity). The ophthalmic system then measuresthe accommodation reflex, accommodation, vergence, and/or pupil size ofthe wearer. Based at least in part on the accommodation, vergence,and/or pupil size of the wearer and the deviation of the wearer'saccommodation, vergence, and/or pupil size from what is expected, theophthalmic system can objectively determine the wearer's opticalprescription. For example, if the wearer's eyes are accommodating at +1D when the image is being put at infinity, the ophthalmic system canobjectively determine the optical prescription.

In some embodiments, the ophthalmic system can be calibrated todetermine the proper diopter and/or account for the proper dioptercorrection based at least in part on the configuration of the displayplatform. For example, when adjusting the depth plane of an image beingprojected to a wearer, the ophthalmic system can be configured to becalibrated to correctly correlate the change in depth plane to a changein diopter or refractive power. In some embodiments, during calibration,the iris of the wearer is analyzed. The iris can be used to uniquelyidentify a patient and this unique identification can be used to accessassociated patient records to correlate the person and their medicalrecords/prescriptions, etc.

In various embodiments, to reduce distraction, the view of the world infront of the wearer's eyes through the augmented reality device isblocked or otherwise not visible during the examination. This can occur,for example, when images are presented to the viewer, although thisapproach is not necessary.

Although the system shown in FIG. 14 has been described as an augmentedreality device, in other embodiments the system may be a virtual realitydevice. In either case, the system may be a system provided by thephysician or clinician for testing at a medical facility or optometristoffice or elsewhere. In other embodiments, the system may belong to theuser and may be employed for other purposes such as entertainment (e.g.,games and movies) and/or work activities. As described above, onebenefit of implementing the examination on the user's system is that theexamination can be conveniently undertaken multiple times (at least 2,3, 4, 5, 6, 8, 10, 12, 16, 18, 24, or more times) throughout the year.In some embodiments, the frequency and/or schedule of examinations canbe based at least in part on the rate of deterioration of the vision ofthe wearer. If the rate of deterioration increases, for example, thefrequency of examinations can increase. Likewise, the examination can beperformed with or without a medical professional, such as optometrist,ophthalmologist, nurse, technician, medical assistant etc.

Red Reflex

The ophthalmic system may also administer a reflex test of the wearer'seye to detect various abnormalities. A reflex test may comprise thesteps of shining or projecting light into a patient's eye such that atleast a portion of the light reflects from a portion of the eye, andobserving a reflection of the light to detect abnormalities. Forexample, red reflex testing allows for the detection of abnormalities ofthe retina based on observing the typically red light reflected from theretina. Red reflex testing can allow for detection of cataracts, cancerof the eye, retinoblastoma, detached retina, glaucoma, strabismus,amblyopia, and aberrations of the eye, including low order and highorder aberrations. Corneal reflex testing, or Hirschberg testing, refersto detecting the light reflected by the cornea, and may be used todetect strabismus, misalignment, asymmetry, or other conditions of thecornea, such as corneal scarring. In some embodiments, reflex testingmay utilize visible light of a single color, multiple colors, whitelight, and/or infrared light to detect abnormalities.

In some embodiments, the ophthalmic system may be a user display device62 such as shown in FIG. 5, which includes a light source such as aprojecting subsystem 18 configured to project light 38 into the eye 20of a wearer. The user device 62 may include a display lens 106 which maybe mounted to a user's head or eyes by a housing or frame 108. Thedisplay lens 106 may comprise one or more transparent mirrors orreflective features positioned by the housing 108 in front of the user'seyes 20 and configured to reflect projected light 38 into the eyes 20(and also potentially facilitate beam shaping). These reflectivesurfaces may be partially transmissive to also allow for transmission ofat least some light from the local environment, e.g., from in front ofthe wearer. FIG. 10D also includes another view of an embodiment of adisplay device comprising a plurality of displays 200, 202, 204, 206,208 that may be utilized to inject light into a plurality of respectivewaveguides 182, 184, 186, 188, 190, each of which may be configured, asdescribed above, to distribute incoming light across the length of eachwaveguide, for exit down toward the eye. Waveguides may project light tothe eye from different depth planes. The displays 200, 202, 204, 206,208 may comprise fiber scanning devices (FSDs) to form the image. Suchdevices can be configured to project light onto a portion of the retinathrough a wave guide stack 178. The system may further include one ormore fiber scanning displays and/or adaptable optics elements, such asvariable focus elements, configured to project light to particularportions of the eye. In some embodiments, the ophthalmic system maycomprise a separate light source in addition to the display device 62for projecting light into the eye so as to form the reflex.

The system can then detect the reflection from the eye of the wearer.For example, the system may include one or more cameras such as eyetracking cameras 24 or similar detection methods to receive a portion ofthe light reflected from the retina, cornea, or other structure of thewearer's eye. The cameras 24 may detect the color and/or intensity ofthe reflection, the shape, position, and/or size of the reflection, orany other detectable quality of the reflected light. In someembodiments, the cameras 24 may capture images of the reflection forimmediate or later analysis. Where testing is performed on both the leftand the right eye of a wearer, the cameras 24 and/or other components ofthe device 62 may compare any qualities of the reflection for the twoeyes so as to detect any asymmetry or other difference between the twoeyes of the wearer. In some embodiments, the system may be configured toadminister an alternating or unilateral cover test to detect oculardeviation. In a cover test, one eye may be occluded, or both eyes may bealternately occluded, to detect motion of each eye when it is occludedor uncovered and/or when the other eye is occluded or uncovered. Theophthalmic system may occlude an eye of the wearer using a spatial lightmodulator as described elsewhere herein, and/or by providing an image toonly one eye or a portion thereof. In various embodiments, testing ofthe left and right eyes may be performed simultaneously or at differenttimes, and may involve one camera 24 or multiple cameras 24. In someembodiments, the camera and/or light source may include one or morelight pipes. Light from the light source may propagate through the lightpipe to the eye or wave guide stack 178. Similarly, light collected by alight pipe or wave guide stack 178 may propagate through the light pipeto one or more cameras.

In some embodiments, reflex testing may be performed along the normalline of sight of a wearer's eye. That is, the light source, camera 24,and or light collected from a common point such as a wave guide or lightguide, may be aligned generally along the normal line of sight (i.e.,within a maximum angle such as ±5 or ±10 degrees of the normal line ofsight) of an eye such that at least some of the projected and reflectedlight travel substantially along the optical axis of the eye. In someembodiments, testing may not be confined to the optical axis and/ornormal line of sight. In such embodiments, the light source may bepositioned so as to project light into the wearer's eye at a firstangle, and the camera 24 may be positioned at a second differentlocation off the normal line of sight where it can receive the reflectedlight. In some embodiments, the reflex testing may include multipleprojections of light from different first angles, either simultaneouslyor separated in time.

Red reflex testing generally involves macroscopic imaging of the retinaof a patient's eye. The camera might focus generally on the eye, and maybe focused on the retina or the cornea, for example. The camera need notzoom in on the retina, as reflex testing does not require the camera toresolve features on the retina. Light can be projected into both eyes ofthe patient, and the reflections from the retina can be imaged orobserved. A normal outcome may be observed if the red color reflected isthe same or similar for both eyes, and if the size, location, and shapeof the reflection is the same or similar for both eyes. If an eyereflects a color other than red, such as grey or white, the presence ofcataracts, retinoblastoma, or other abnormalities may be indicated.Different sizes or shapes of reflecting regions between the two eyes mayindicate other abnormalities such as refractive errors, misalignment,strabismus, unequal refraction, or other conditions. Refractive errorsmay be observed as linear or crescent-shaped regions of the retina thatdo not display a red reflex. For example, hyperopia may result in anupward-facing crescent, while myopia may result in a downward-facingcrescent.

Observation of the retina may be facilitated by the application ofmydriatic agents to induce pupil dilation and avoid pupil contraction inresponse to the projected light. Mydriatic agents may be variousmydriasis-inducing drugs such as tropicamide or the like, and are wellknown for use in optical examinations. Other solutions for reducingpupil contraction or inducing dilation may be used. This solution may bedelivered by a port on the ophthalmic display such as describedelsewhere herein. In some embodiments, observation of the retina may beperformed without mydriatic agents by using a short flash of light,rather than a steady light source. If a short flash of light is appliedwhile the pupil is not contracted (e.g., due to being in a darkenedroom), the reflected light from the retina may be observed brieflybefore the pupil has contracted in response to the light. Thisphenomenon causes the red-eye effect commonly seen in photography.Accordingly, the light source may be configured to deliver a brief flashof light, and inward-facing cameras may be configured to capture animage of the reflected light after an appropriate time delay.

For purposes of red reflex testing, reflected light is frequentlyapplied and viewed at distances between approximately 8 inches and 4feet from the eye of the patient. If testing is performed with a closerhead-mounted ophthalmic device, it may be impractical to mountilluminating or receiving devices at far distances from the eye. Thus,optical elements within the device may be used. For example, theophthalmic system may include one or more lenses, such as negative powerlenses, allowing projection of light that appears to be from a moredistant depth plane. Similarly, lenses may be configured to form avirtual image corresponding to an ordinary reflex test viewing distancewhich may be detected by a camera 24 disposed within the head-mountedophthalmic system. In some embodiments, a light source and/or imagesensor may be mounted on a portion of the head-mounted ophthalmic systemsuch as an ear frame, and mirrors may be used to create a longerprojection and/or viewing distance.

Corneal reflex testing, such as the Hirschberg test, may use a fixationtarget for the wearer. For example, the wearer may be given a fixationtarget at the center of the field of view. In some embodiments, thefixation target may be located away from the center of the field ofview. The fixation target may additionally be projected at multipledepth planes, such as by use of a wave guide stack 178. The depth of thefixation target may be varied during testing, such as by presenting afirst fixation target at a first depth plane or location at a firsttime, followed by additional fixation targets at different depth planesor locations, so as to cause the wearer's eye to accommodate. Thefixation target may be a small image, such as a dot or a recognizablepicture, a dark spot in an image, or the like. Once the wearer's gaze isfixed on the fixation target, a difference in location of the corneallight reflection between the two eyes of the wearer may indicate thepresence of strabismus. In some embodiments, the projected light may betailored for reflection from the cornea, rather than reflection fromother structures of the eye. For example, the light may be of lowerintensity than the light used for red reflex testing so as to avoidgenerating a strong reflection from the retina. Moreover, corneal reflextesting may be performed without the use of mydriatic agents. In theabsence of a mydriatic agent, the pupil may contract in response to theprojected light, further reducing any retinal reflection that mayinterfere with the observation of the corneal reflex. In someembodiments, the system may use cover testing by occluding, defocusing,blurring, and/or de-emphasizing one eye of the wearer while leaving theother eye uncovered. Occlusion of one eye may be simulated by projectingthe fixation target to the other eye only.

In some embodiments, results of various reflex tests may be imaged, suchas by cameras 24, and stored for analysis. Once stored, the test resultsmay be compared with known, published, or otherwise available data fromnormal and/or abnormal results of reflex testing. For example, an imageof the red light reflected from a patient's retina may be compared withan image of the red light reflected from a normal retina (that is, aretina not exhibiting characteristics of any detectable abnormality) todetermine if any abnormality is present. If a portion of a patient's eyedoes not appear consistent with a normal eye condition, the test datamay further be compared with imaging data of various known abnormalitiesso as to accurately diagnose the abnormality of the patient's eye.

Intraocular Pressure

In one or more embodiments, the augmented reality or virtual realityophthalmic system may be configured to measure intraocular pressure ofthe user's eye. Referring back to FIG. 5, this embodiment may beimplemented by configuring the ophthalmic system 62 with one or moreadditional components along with necessary circuitry and processingpower. In one or more embodiments the ophthalmic system may be designedto include the additional components/sensor(s), or in other embodiments,the additional components may be add-ons to the ophthalmic system.

Intraocular pressure (IOP) is typically governed by the amount ofaqueous fluid pressure inside the eye. While some variation in IOP isnormal (e.g., between day and night), higher IOP levels or significantdifferences between IOPs of the left and right eye can be an indicationof other physiological issues liked glaucoma, iritis, retinaldetachment, uveitis and comeal thickening. IOP typically is normallybetween approximately 10 and 21 mm Hg, with an average of about 15 or 16mm Hg, varying by approximately 3.5 mm Hg over the course of a day.

In some embodiments, the ophthalmic system may use tonometry todetermine IOP. The system may use contact tonometry by applying contactforce to flatten a constant area of the cornea and infer the IOP fromthe applied force and consequent response. In some embodiments, thesystem may use non-contact tonometry by applying a rapid pulse of air,acoustic pressure, or other indirectly applied force to flatten thecornea and detect comeal applanation via an electro-optical system. Thesystem may also include an optical coherency tomography (OCT), such asthe OCT system describe herein and use this OCT system to measure anocular reaction using 3D imaging. Compression may be determined bymeasurement of changes in the curvature of the cornea or movement of theapical corneal interface in relation to posterior interfaces such as theretina.

The ophthalmic system 62 as described may be configured to measureintraocular pressure using optical or ultrasonic measurement technology.In some embodiments, the system 62 may apply a force to inducecompression of the cornea and use optical or ultrasonic detectionmethods to monitor the response to determine the pressure within theeye. Force may be applied by mechanical compression, a burst of air,and/or acoustic waves such as ultrasound. In other embodiments, thesystem may use optical, ultrasonic, and/or photoacoustic detectionmethods to determine the pressure within the eye without applying aforce to the eyes. For example, ultrasound or acoustic waves can be usedto perturb the surface of the cornea. Imaging methods, includingultrasound imaging can be used to measure the resultant change in shape,e.g., applanation of the cornea. In some embodiments, 3D optical imagingand/or ultrasound may be used to determine a density of the fluid withinthe eye, which may be used to calculate the intraocular pressure basedon known properties of the fluid. Such ultrasound systems are describedelsewhere herein, for example, with reference to FIG. 24A, 3D opticalimaging systems may be capable of determining a density or change indensity of the fluid based on known light absorption and/or reflectionproperties. The system may further include a temperature sensor, such asa non-contact infrared thermometer or other suitable temperature sensor,to detect temperature changes in the eye that may affect the reliabilityof any of the measurements described above.

The system may further include a sensor and processor 32 configured todetermine the intraocular pressure of an eye 20. The sensor may be anytype of monitoring device including a light sensor, a 2D imaging head,an interferometry 3D imaging head, and/or other sensors. In someembodiments, the ophthalmic system may use ultrasound or photoacousticultrasound for imaging instead of or in addition to the optical sensingtechnologies described above. For example, ultrasound or opticaltime-of-flight measurements may be taken to determine any change in oneor more properties of the cornea of the wearer's eye due to an appliedforce. Ultrasound time-of-flight measurements may further be used todetermine an intraocular pressure of the eye without applying a force tothe eye, as the density of the fluid within the eye is dependent on theintraocular pressure and affects the speed of ultrasound waves withinthe eye. Decreased time-of-flight may indicate a higher fluid density,which may be correlated with higher intraocular pressure. In someembodiments, intraocular pressure may be determined based on the shape(e.g., applanation), tension, or other characteristic of the exteriorsurface of the eye. The sensors described above may comprise any cameras16 or 24 of the ophthalmic system 62, or may be additional elements. Forexample, in embodiments using ultrasound or photoacoustic ultrasoundimaging, the sensors may comprise one or more ultrasound transducersconfigured to generate an electrical signal based on detected ultrasoundwaves. Similarly, the sensors may comprise cameras configured to detectvisible or infrared light as appropriate in embodiments using visiblelight or infrared imaging or optical sensors.

In some embodiments, a light source such as a fiber scanning display(FSD) 18 or a separate light source element may project beams of light38 into the user's eyes, as described elsewhere herein. The light sourcemay further include an adaptable optics element 316 b, variable focuselement 316 a, waveguide stack 178, and/or one or more lenses, also asdescribed elsewhere herein herein and depicted in FIG. 10E. The lightsource may further be configured to project light into the wearer's eyefrom different depth planes. In embodiments in which the light sourcecomprises a fiber scanning display, the fiber length of the display maybe variable. The light source may be a display or a separate lightsource. In one or more embodiments, a set of parameters associated withbackscattered or reflected light may be measured by the FSD or otherlight monitoring device or photo-detectors (as described herein, a FSDmay be used to collect light). The pattern of backscattering orreflection of the emitted light may be an indicator of the intraocularpressure of the eye, especially when compared to previous measurements.For example, as shown in FIG. 16A, a light emitter 1640 may emit a beamof light 1642 in the direction of the cornea 1625 of a wearer's eye1620. A portion of the beam may be reflected as a reflected beam 1644,which may enter a light detector 1646. The remainder of the incidentlight beam 1642 may be scattered elsewhere. A compression inducingdevice, such as an air tube 1630, may induce applanation in the cornea1625, such as by emitting an air jet or pulse 1635. Lower IOP willresult in greater applanation, creating a larger and flatter reflectivesurface, resulting in more of the incident light beam 1642 beingreflected to the light detector 1646. Thus, a smaller number ofreflected light rays to the light detector may be an indication of highIOP, in one or more embodiments. A greater number of reflected lightrays to the light detector may be an indication of low or normal IOP, aslower IOP results in more significant applanation, causing more lightrays to be reflected. Other configurations are also possible.Additionally, a wavelength of the light projected into the eye may bechanged to provide depth information. For example, infrared wavelengthsmay penetrate deeper into the eye.

In some embodiments, optical sensing may include analysis of one or morePurkinje images of the wearer's eye. For example, the sensor may beconfigured to detect the first Purkinje image produced by the reflectionof light from the outermost surface of the cornea, also called the P1image, cornea reflection, or glint. The sensor and processor may analyzethe presence, shape, location, intensity, or other detectablecharacteristic of the glint. Based on glint analysis, vergence,accommodation, curvature, applanation, or other characteristics of theeye may be observed. Repeated measurements may allow for detection ofchanges in any of the characteristics listed above. In some embodiments,the glint analysis may include measurement of glint characteristicsduring induced changes in accommodation or vergence to increase theaccuracy and reliability of IOP measurements based on the detected glintcharacteristics, for example, as a noise filter.

The processor 32 of the ophthalmic system shown in FIG. 5 can beconfigured to determine an intraocular pressure based on the output ofany of the sensors described above. For example, the processor maycompare output data from one or more sensors with a correlation databasethat correlates detected parameters with known IOP values. Correlationdatabases may be stored locally in a memory circuit of the ophthalmicsystem, or may be stored remotely and accessed via wirelesscommunication. The processor 32 may further be configured to detect thepresence of ocular hypertension based on the determined intraocularpressure, as well as other information such as a threshold pressuredefining ocular hypertension or other medical information. The thresholdpressure values and any other relevant information may be stored locallyor remotely, as described above for correlation databases.

In addition, the ocular pulse of an eye may be monitored based ondetection of IOP as described above. An ocular pulse occurs due topulsatile ocular blood flow into the choroid, or vascular layer of theeye. The IOP of an eye changes slightly each time blood is pumped intothe eye. Thus, an oscillation of the IOP may be observed matching therate of the ocular pulse, which may be the same or substantially thesame as the heart rate of the wearer. In addition, there may be asystolic and diastolic IOP which may be correlated with the systolic anddiastolic states of the cardiac cycle. Thus, increased IOP may becorrelated with increased blood pressure. Further, the ocular pulseamplitude (OPA), the measured difference in IOP between the systolic anddiastolic cardiac states, may be used as a diagnostic screening tool forcarotid artery stenosis. Low OPA may indicate the presence of carotidartery stenosis, with lower amplitudes indicating more severe stenosis.OPA may also be positively or negatively correlated with the presence ofglaucomatous damage, the axial length of the eye, and/or other ocularcharacteristics or hemodynamics. OPA may be measured repeatedly over aperiod of days, months, or years, with upward or downward trends in OPAindicating similar trends in the blood pressure of the wearer.

Referring now to FIG. 16B, an example process flow 1600 for determiningIOP is disclosed. At 1602, an eye pressure test program is initiated. At1604, light is projected into a known portion of the user's eye(s). At1606, the pattern or amount of backscattered or reflected light emittedin response to the projected light is measured. As noted above, this maybe performed by the FSD itself, in some embodiments, or through aseparate light measuring module. In some embodiments, 2D or 3D imagingmay be used instead of or in addition to detecting the amount ofbackscattered or reflected light, as described above. As describeherein, optical imaging, OCT imaging, etc. of the eye, for example, ofthe cornea may be used to determine applanation or change in surfaceshape. Ultrasound and/or photoacoustic ultrasound may be used, forexample, to image the shape of the eye to determine the extent ofapplanation of the eye. In some embodiments, applanation may be detectedby interferometry. An interferometer, for example, can detect smallchanges in distance. Accordingly, an interferometer could be used todetect changes in the position of a surface on the eye such as thecornea.

At 1608, the system may consult a correlation database. The correlationdatabase may be a predefined database that correlates the pattern oramount of backscattered light from eye tissue with known IOP values. Insome embodiments, the correlation table may correlate other qualities,such as applanation or other eye shape data, with corresponding IOPvalues. At 1610, the results may be presented to a user or clinicianadministering the eye pressure test. In some embodiments, the resultsmay be analyzed locally at the ophthalmic device. In other embodiments,the results may be transmitted to a remote location for analysis,determination of IOP and/or diagnosis of ocular hypertension.

Intraocular pressure testing as described above may be performed indiscrete tests on demand, or may be performed periodically and/orrepeatedly over time. Repeated analysis may allow for the tracking ofcyclic variations or long-term progression of IOP in a wearer. Thus, IOPtesting functions may be incorporated into a device worn only forophthalmic diagnosis, or may be a part of a device worn regularly, suchas for entertainment, work, or other purpose(s), so that examinationsmay be performed automatically at regular intervals and/or at varioustimes of day, week, month, year, etc. In some embodiments, therefore,the intraocular pressure is measured by the device at least 2 times, 3times, 4 times, 6 times, 8 times, 10 times 12 times, 16 times, 18 timesa year or more. In some embodiments, the intraocular pressure ismeasured by the device at least 2 times, 3 times, 4 times, 6 times, 7times, 8 times, 10 times 12 times, 14 times, 16 times, a week or more.In some embodiments, the intraocular pressure is measured by the deviceat least 1 time, 2 times, 3 times, 4 times, 6 times, 7 times, 8 times,10 times 12 times, 14 times, 16 times, a day or more. Repeated and/orperiodic testing within a day may provide a measurement of a wearer'sdaily variation in IOP. Repeated and/or periodic testing over longerperiods of time, such as weeks, months, years, etc., may allow long-termdecreases or increases in IOP to be tracked, for example, to detectincreasing IOP before ocular hypertension occurs, or to monitor theeffectiveness of treatment for diagnosed ocular hypertension. In someembodiments, the frequency of regularly scheduled tests may beautomatically adjusted based on trending increase or decrease ofintraocular pressure testing results. The system may also be configuredto alert the wearer and/or a clinician when abnormally high IOP or otheranomaly is detected.

Pinhole Occluder

In one or more embodiments, the ophthalmic system may be used for avisual acuity test, similar to visual acuity tests administered througha pinhole occluding device. Pinhole occluding devices focus light andremove the effects of refractive errors (e.g., such as myopia,hyperopia, etc.). Because, with a center-hole pinhole occluder, lightpasses only through the center of the eye's lens, any defects in theshape of the lens have little or no effect. In some implementations, apinhole occluding device may be used to identify visual defects causedby refractive error from visual defects caused by other errors. Forexample, the pinhole occluding device can compensate for mydriaticpatient's inability to contract the iris.

In one or more embodiments, the ophthalmic system may provide a versionof the pinhole occluder. For example, the ophthalmic system may occludethe field of view for one or both eyes such that peripheral viewing isoccluded, but central view (i.e., through the pinhole) is maintained.Accordingly, in various embodiments, the ophthalmic system may occlude,obstruct, de-focus, deemphasize, or block some or a portion of the lightrays that contribute to forming an image from entering the eye of auser.

In one implementation and without subscribing to any scientific theory,the ophthalmic system may utilize the pinhole occluder device to providea means for diagnosing defects in the eye. The ophthalmic system may beconfigured to occlude the field of view for one or both eyes such thatperipheral viewing is occluded, while the central view (i.e., throughthe pinhole) is maintained. For example, if vision is improved by usinga pinhole occluding device with the ophthalmic system, this may beindicative of a refractive error in the peripheral regions or peripheralcataract. Or, if vision is worsened by using the pinhole occludingdevice, this may be indicative of macular degeneration, or central lensdefects. If there is no change in vision quality, then the eye may benormal, or may suffer from amblyopia (“lazy eye”) as discussed above.Accordingly, the ophthalmic system may be configured to automatically orinteractively obtain information regarding the health state or conditionof a user and/or of the user's abnormalities.

In another implementation and without subscribing to any scientifictheory, the ophthalmic system may be configured to correct for visiondefects of the user by utilizing a pinhole occluder device. For example,if a user having refractive errors at the peripheral of the eye, theophthalmic system may occlude the field of view for one or both eyessuch that peripheral viewing is occluded, but central view (i.e.,through the pinhole) is maintained. Thus, the light rays from theperipheral are occluded and do not interact with the refractive errorsof the user's eye, thus the user's vision may be improved. Similarly,the pinhole occluder may correct for other vision defects not limited torefractive errors, for example, scotomas (e.g., blind spots) ineccentric (non-foveal part of the eye) vision among others. In anotherimplementation, the ophthalmic device may be configured to applymultiple pinholes to the display device, which each individuallyfunction as aperture or field-stops (e.g., occluding extraneous lightrays). Such configurations may result in improved focusing of an imageby the eye. For example, and without subscribing to any scientifictheory, employing multiple pinholes allows light to be passed throughthe pinhole and propagate through a small area of the lens of the eye.Because light passes only through the small area of the eye's lens,defects in the shape of the lens may have reduced effect. Thus, whilemore light is passed through the multiple pinholes, the rays do notinteract with surface defects in the eye.

In some embodiments, the ophthalmic system may be an augmented realitysystem that corrects for vision defects. As described above, theophthalmic system may be an augmented reality head mounted displaysystem configured to apply a pinhole occluder device to ambient lightfrom the world in front of the user, as well as applying the pinholeoccluder device to AR image content generated by the ophthalmic system.Alternatively, the ophthalmic system may be a VR head mounted displaysystem configured to produce VR image content generated by theophthalmic system, apply a pinhole occluder, and provide the VR contentto the user while the user's eyes are covered from ambient light infront of the user by the VR head mounted display system. As describedpreviously, a VR head mounted display system may include front facingcameras (e.g., cameras (16) of FIG. 5) configured to capture ambientlight from the world in front of the user, and generate and projectcorrected wavefronts of these images into the eye of the wearer.

In various embodiments, the ophthalmic system may be a patient-wornophthalmic device as illustrated in FIGS. 3A-3D and 5 and as describedabove in connection with correcting for myopia, hyperopia, astigmatism,and other refractive errors. Accordingly, it will be understood that thedescription and components described above related to ophthalmic devicesdisclosed herein for correcting for vision defects applies equally here.

For example, as described above, the ophthalmic device may include anaugmented (or virtual) reality display device (62) that includes adisplay lens (106) and a light source (18) configured to project light(38) that is directed into the eyes of a user to form images in the eyeof the user for the user's viewing. In various embodiments, this displaydevice (62) comprises a waveguide stack (178) that received light from afiber scanning display disposed at the edge of the waveguide stack (178)and couples the light out of the waveguide from the backside thereof tothe wearer's eyes. In the case where the display device (62) is anaugmented reality display device, the ophthalmic device may also directambient light from the surrounding world, e.g., light from in front ofthe user, to the eyes of the user through display lens (106). This lightmay, for example, be transmitted through the waveguide stack to thewearer's eye. As discussed above, the display device (62) may alsocomprise one or more adaptable optics or variable focus elements (VFEs)(e.g., VFEs 316 a and 316 b). As described above, the adaptable opticsmay be an optical element that can be dynamically altered so as to alterthe wavefront incident thereon. For example, the adaptable optic may bea reflective optical element such as a deformable mirror or areconfigurable transmissive optical element such as a dynamic lens, suchas described above in FIGS. 10B-10E.

In one or more embodiments, the ophthalmic system disclosed herein mayinclude a pinhole occluder, as described below in accordance with FIGS.17A and B. In various embodiments, a pinhole occluder may beincorporated into an ophthalmic system, for example, as a part ofdisplay device (62). Or, in some embodiments, a pinhole occlude may be aseparate component that may be positioned onto the ophthalmic system,for example, mechanically attached thereto.

It should be appreciated that the peripheral field of vision (e.g., FIG.17B), the central viewing (e.g., FIG. 17C) or any target region may beoccluded either by digital means or physical means. For example,physical means may include a mechanical opaque filter configured toinclude a pinhole disposed at a desired location. In some embodiments,one or more spatial light modulator (e.g., FIGS. 10B and 10C) may beencoded to generate a pinhole occluder, which may be adjusted based onthe desired location of the pinhole.

In some embodiments, the ophthalmic system may occlude portions of ascene digitally. For example, local processing module (70) may retrievean image stored in a digital memory and/or remote data repository (74)to be presented to the user through the display device (62). Theophthalmic system may include local processing module (70) configured toperform instructions to modify the image so as to mimic a pinholeocclude in the 2D image generated by the ophthalmic device.

In another implementation, the scene may be digitally occluded byde-focusing one or more regions of the image and focusing other regionsof the image. The focused regions may correspond to a pinhole, while theout-of-focus regions may correspond to an occluded region. In someembodiments, the ophthalmic device may utilize a waveguide stack (178)(e.g., FIG. 10D) to present one or more regions of the image in focussurrounded by out-of-focus regions by selectively addressing waveguidesto project light at various focal depths as described in FIG. 10D. Insome embodiments portions of the image corresponding to the small regionto be viewed may be presented at a first depth plan with the wearer isfocused. Conversely, other image content outside that small region maybe presented at a second depth plane. This image content on the seconddepth plane may be purposely blurred or may be blurred when the view isfocused on the image content of the first depth plane or both.

In another implementation, the scene may be occluded to present one ormore regions of the image with enhanced chroma (e.g., color) or luma(e.g., intensity). For example, a selected region to represent a pinholemay be enhanced by applying more power to the light source (18) orincreasing the output of the light source (18), while surroundingregions remain unchanged or experience a decrease in chroma or luma.

Without subscribing to any scientific theory, by increasing the chromaand/or luma of the selected regions relative to the remaining regions,the selected regions may be become more dominate. For example, theophthalmic system may enhance the chroma and/or luma of a central regionof the image. This may cause the central region to appear brighter andmore prominent as compared to peripheral regions of the image, thusviewed more clearly by the user. The regions of the image that areenhanced may correspond to regions of the eye identified as havingvisual defects. Thus, light rays passed through the regions of the eyethat do not have defects are more dominant and easier to view than theregions of the eye having vision defects.

FIG. 17A depicts an illustration of a scene (1720) viewed by eyes of auser through an ophthalmic device, for example display lens (106) ofFIG. 5, in accordance with various embodiments disclosed herein. Thescene may be an image displayed by the ophthalmic device. Or, the scenemay be ambient light passed to the user from in front of the user andthe ophthalmic device. Or, the scene may be a combination of the ambientlight and images displayed by the ophthalmic device. As illustrated,scene (1720) may comprise a person (1721) located at approximately thecenter of the scene, a tree (1722) located off from the center of thescene, and sun (1723) located along the peripheral of the scene (1720).It will be understood that scene (1720) is for illustration purposesonly, and that any scene may be used, including but not limited to, ascene comprising ambient light form the surrounding world form, VR imagecontent and/or AR image content, as described herein.

FIG. 17B illustrates a scenario where the ophthalmic system isconfigured to occlude the peripheral viewing regions of the scene, butcentral regions (e.g., as viewed through the pinhole) are maintained. Insuch an implementation, the pinhole occluder operates as an aperture orfield stop that stops down light from the peripheral. For example, theophthalmic system may implement an occluder (1730 a) having a pinhole(1735 a) located along the line of sight optical axis of the eye. Theoccluder (1730 a) may be positioned such that light rays from person(1721) pass through the display lens 106 and are viewed by the eye. Incontrast, light rays from tree (1722) and sun (1723), respectively, areoccluded. In some embodiments, the occluder may comprise one or morespatial light modulators such as liquid crystal spatial light modulatorsthat control the intensity of light transmitted through or reflectedfrom a plurality of separate electrically reconfigurable pixels. Inaddition to being implemented physically, the occluder (1730 a) may beimplemented digitally as described herein. For example, image contentpresented on a display may be limited to a small region as if havingbeen occluded. Similarly, the image that can be viewed on a display canbe limited to a small portion of the display by altering the pixelsoutside said small portion such that said image less discernable than insaid small portion of said display. The processing electronics thatcontrol the display such as the fiber scanning display can implementsuch modification to the image content.

In various embodiments the region 1730 a that light passes through,e.g., the pinhole, may be circular, square, oval, rectangular or anyother shape. For example, the region 1730 a may have lateral dimension(e.g., diameter, width, length, etc.) between about 0.5 mm and 2.0 mm.Accordingly, the “pinhole” should not be limited to sizes less than onemillimeter, as other dimensions are possible. For example, a pinholehaving smaller dimensions may provide vision acuity testing while apinhole of larger dimensions may provide for testing for reduced visionvia decreases in retinal illumination.

FIG. 17C illustrates another embodiment, where the central region may beoccluded while one or more portions of the peripheral region is passedto the eye to test peripheral vision. For example, the ophthalmic systemmay apply an occluder (1730 b) having a pinhole (1735 b) located off ofthe line of sight or optical axis of eye along the peripheral of view ofscene (1720). Occluder (1730 b) may be positioned similarly as occluder(1730 a). For example, the occluder (1730 b) may be positioned such thatlight rays from sun (1723) pass through the lens display (106) and areviewed by eye. Whereas, light rays from person (1721) and tree (1722),respectively, are occluded. Similar to that depicted in FIG. 17C (notshown), any area of the eye except specific targeted regions may beoccluded to test for those targeted areas. In such embodiments,referring to scene (1720), from tree (1723) located off the normal lineof sight of the eye and/or the center axis pass through the ophthalmicsystem, while light rays and from the person and sun, respectively, areoccluded.

In some embodiments, diagnosing refractive errors may comprise testingdifferent regions of the eye by measuring the user's response to variousstimuli at the different regions and comparing the results, for example,in a test implemented similar to visual field testing as describedherein. Similar to the small dot that is moved around the visual fieldof the user, the pinhole may be moved around the visual field todiagnose or test various parts of the eye. The ophthalmic system maycomprise a spatial light modulator, as described above, configured toproject a raster pattern comprising a pinhole occluder. Although thepinhole can be rastered, in other embodiments, the pinhole can be movedabout other than in a raster, such as randomly. In one or moreembodiments, the ophthalmic device may have a feedback mechanism (e.g.,user interface controls) to adjust the pinhole occluder. The user mayinput a response (e.g., improved or worsened vision) based on theoccluding of an image. The ophthalmic system may analyze the user inputsthrough a pinhole occluding test program (e.g., described below in FIG.17D), executed by the local processing module (70). The pinholeoccluding test program may be pre-coded (e.g., stored in a digitalmemory of local processing module (70)) or downloaded onto theophthalmic system from a remote data repository (74).

Thus, for example, if the user indicates that vision improved whenapplying a pinhole occluder (e.g., occluding the center, peripheral, orany other region of the eye), this may be an indicative of a refractiveerror in that region or peripheral cataract where the region is thecenter of the eye. Or, if the user indicates that vision worsened whenapplying a pinhole occluder, this may be indicative of maculardegeneration, or central lens defects. If the user indicates that thereis no change in vision quality, then the eye may be normal, or maysuffer from amblyopia (“lazy eye”) as discussed above. It should beappreciated that the system may analyze the results through a pinholeoccluding test program (e.g., FIG. 17D). The pinhole occluding testprogram that may be pre-coded or downloaded onto the ophthalmic system.Similar to the approaches discussed above, different regions of the eyemay be tested by measuring the user's response to various stimuli at thedifferent regions and comparing the results.

Additionally, in one or more embodiments, the ophthalmic system mayenable a user to manually adjust a focus dial to determine one or morerefractive errors. A virtual phoropter, similar to the one discussedherein, may apply various optical powers in sequence, allowing the userto indicate which version is clearer. This, in turn, may determine theuser's prescription from the series of user responses. In otherembodiments, a Scheiner double pinhole alignment examination orShack-Hartmann grid alignment examination may be similarly administeredthrough the ophthalmic device. Any of these systems may be used inconjunction with pinhole occlusion.

In one or more embodiments, the ophthalmic device configured to operateas a pinhole occluder may include any of the features and components ofsystems devices, and methods described herein. For example, theophthalmic system may comprise one or more sensors configured to detectreal-time information of the world surrounding the user. For example,the ophthalmic system may include a plurality outward facing cameras tocapture an intensity image of ambient light from the surrounding worldin real-time. For example, the ophthalmic device may include one or morewide-field-of-view machine vision cameras (16) operatively coupled tolocal processing module (70). These cameras may be configured to imagethe environment around the user and detect an amount of light. In oneembodiment these cameras (16) are dual capture visible light/infraredlight cameras. Images taken by cameras (16) may be stored in a digitalmemory of the ophthalmic device and retrieved for subsequent processingand re-rendering in display device (62).

In some embodiments, images of ambient light of the world surroundingthe user from in front of the user captured by the outward facingcameras may be re-rendered in the display device (62) and occludedaccording to the description here. For example, the re-rendered imagesmay be digitally occluded, as described above, but increasing theclarity and/or focus of a region (e.g., the pinhole) and blurring ordefocusing other regions. Similarly, the chroma and or luma of the arearepresenting the pinhole may be enhanced so that the brightness isincreased or there is stronger contrast. The re-rendered image may thenbe projected to the user by the display device (62). These embodiments,may be utilized to diagnose and, in some embodiments, be a therapeutictool for, macular degeneration, color blindness, etc., as describedelsewhere in reference to macular degeneration.

In one or more embodiments, the ophthalmic system may comprise one ormore sensors configured to detect real-time information related to atleast one of user's eye. In one or more embodiments, as described above,the ophthalmic system may comprise one or more sensors configured todetect an orientation of a user's gaze. In another embodiment, in thealternative or in combination, the user's gaze may be estimated ordetected based on tracking one or more eyes of the user through an eyetracking system, as described above. For example, the user's gaze may beestimated or detected based on a user's head position, head pose, ororientation, e.g., forward tilt, as well as based on the angle ofconvergence triangulated through imaging the eye and imaging thesurrounding world, as described above.

In some embodiments, the ophthalmic device may comprise gyroscopicsensors configured to determine a gaze orientation based on headpositions or head movement of the user (e.g., straight, tilted down,looking up, etc.). In some embodiments, the display device (62) maycomprise a sensor assembly (39) having accelerometer, gyroscope, and/orother types of orientation and/or movement sensors several of which arediscussed elsewhere herein. The sensor assembly (39) may be configuredto detect movement imparted onto and orientation of the display device(62) due to movement of the user's head. The display device (62) mayalso include processor (32) (e.g., a head pose processor) operablycoupled to the sensor assembly (39) and configured to execute digitaland/or analog processing to derive head positions from movement detectedby the sensor assembly (39). In one embodiment, sensor assembly (39) maygenerate movement data stored in a digital memory. The processor (32)may retrieve this movement data and execute processing logic todetermine one or more head positions. In some embodiments, the headmovement data may be used to reduce noise while diagnosing visualdefects (e.g., detecting a head movement during a test may be indicativeof a faulty test and result).

In one or more embodiments, real-time information related to the user'seyes may also be based on tracking eye movement through an eye trackingsystem. As described above, in various embodiments, the ophthalmicsystem may utilize inward facing cameras (24) (e.g., infrared cameras)to track an eye, which can be operatively coupled to the localprocessing module (70). The local processing module (70) may includesoftware that, when executed, may be configured to determine theconvergence point of the eyes, as described above in reference to FIGS.5 and 6 and/or the direction of the eyes. From this determination, theophthalmic system may also execute logic devices to determine a focuslocation or depth based on the eye tracking.

As described above, in some embodiments, the ophthalmic system mayutilize an eye-tracking system to triangulate the user's convergencepoint and the angle of convergence. For example, while the user's headposition may remain unchanged, the user's eyes may move which may betracked by the eye-tracking system. For example, as a user glancesdownward, for example, to look at a book, the system may monitor the eyemovement and determine that the convergence point has moved inward anddownward and that the associated convergence angle has increased. Insome embodiments, an increase in the convergence angle may be indicativeof the eye focusing on an object located at a near-field focal depth(e.g., a book).

In another embodiment, the system may track the eye movement based onglint detection or Purkinje fringes, as described above and elsewhereherein. For example, the camera (24) tracks the position of a glint withrespect to features of the eye (e.g., edge of the eye, intersection ofthe eye with an eye lid, pupil, etc.).

In various embodiments, the ophthalmic device may comprise a biofeedbacksystem, as described herein, configured to determine a comfort level ofthe user in viewing an object or image. For example, if a user's eyesare shifting, unstable, oscillating, changing (e.g., in an unsteady orrandom manner) accommodation, etc., these may be indicators that theuser is unable to comfortably view the object. Instability oroscillation in accommodation or behaviors associated with accommodationmay be a sign the user is struggling with focusing on an object orimage. Accordingly, the biofeedback system may receive real-time inputsrelating to the state of the user's eye, e.g., abnormal or unsteadyfluctuations in the accommodation and/or behaviors associated withaccommodation.

Referring now to FIG. 17D, an example process flow 1700 is illustratedfor diagnosing vision defects utilizing a pinhole occluder program. Insome embodiments, process flow 1000 may be performed by patient-wornophthalmic devices, such as those described in connection with FIGS.3A-3D. The process flow 1700 can be implemented by the local processingmodule (70), for example, by executing logic devices to performinstructions stored in a digital memory operatively connected to thelocal processing module. Process flow 1700 may be performed by anophthalmic device as describe herein comprising, for example, adaptiveoptics, VFEs, and/or waveguide stacks as shown in FIGS. 10B-10E. Theophthalmic device may include a light source having a fiber scanningprojector, as described above.

At 1702, a pinhole occluding program is initiated. At 1704, a region ofthe eye is selected. For example, the region maybe selectedautomatically by the ophthalmic system performing the occluding program.In some embodiments, the program may select a central viewing region ofthe eye, a peripheral region of the eye, or any target region of theeye, which may be located based on tracking the eye using inward facingcameras (e.g., cameras (24)). The program may define one or more ofregions of the eye to locate a pinhole thereby testing multiple areas ofthe eye. Based on the number of positions and the step size betweeneach, the program may be configured to test the majority of the eye. Inother embodiments, alternatively or in combination, the region may bemanually selected by the user through a user interface of the ophthalmicdevice.

At 1706, all other regions of the eye except the selected region may beoccluded, as described above. For example, the local processing module(70) may be operatively coupled to one or more mechanical opaquefilters. The local processing module (70) may execute instructions tocause the filters to position a pinhole or other transparent region atthe determined location. The local processing module (70) may executeinstructions to occlude the regions not selected by the program. Invarious embodiments, alternatively or in combination, the localprocessing module (70) may be operatively coupled to one or more spatiallight modulator to effect the occluding of the other region or regions,as described herein.

At 1708, a stimulus (e.g., an image, a virtual phoropter, etc.) ispresented to the user. For example, the ophthalmic system may projectlight (38) to the eye of the user through display device (62) to producean image visible to the user. In another embodiment, the image may bebased in part on ambient light passed to the user through display device(62) from in front of the user. In yet another embodiment, the image maybe an image obtained by outward facing cameras (e.g., cameras (16))imaging ambient light from in front of the user and then displayed bythe ophthalmic device to the user.

At 1710, the ophthalmic system receives input from the user regardingthe image presented to the user by the ophthalmic device via thefeedback mechanism. For example, a user may be able to indicate that theimage is viewable or not, clear, in focus, or not, etc. Based on theuser input, the ophthalmic system may be able to determine the health orcondition corresponding to the selected region of the eye. As describeabove, for example, if the user input is that the stimuli has improveddue to implementing the occluding program, this may be indicative of arefractive error or cataract outside of selected region of the eye. Or,if user input is that the stimuli is worsened by using the occludingprogram, this may be indicative of macular degeneration, or lens defectsat the selected region of the eye. If there is no change, then thatportion of the eye may be normal, or may suffer from amblyopia (“lazyeye”) as discussed above.

In some embodiments, the ophthalmic system may comprise an inward facingcamera configured to provide inputs related to vision quality. Theinward facing camera may be coupled to a light source that projectslight through the pinhole occluder and into the eye. The projected lightmay be received by the retina, being at least partially occluded. Theophthalmic system may store or be provided with an expected pattern oflight to be returned, e.g., a normal return pattern based on a healthyeye. The inward facing camera may detect a pattern of light reflectedfrom the retina, and the ophthalmic system may compare the reflectedlight pattern against the expected healthy pattern. From this, thesystem may be able to objectively determine vision quality withoutrequiring user input. For example, light projected through the center ofthe pupil incident on the fovea should be reflected straight backunaffected. However, if the eye has a refractive error, then thereflected pattern detected by the camera will be refracted based on thiserror resulting in an abnormal reflection pattern.

In some embodiments, the input from the user may be stored in thedigital memory of the local processing module (70) for subsequentaccess, retrieval, or processing. The user input may be associated withthe selected region of the eye, which may also be stored in the digitalmemory. In another embodiment, the local processing module (70) may beoperatively coupled to remote processing module (72) and remote datarepository (74), where the input and regions may also be stored andassociated.

At 1712, the ophthalmic system determines whether other regions are tobe similarly tested. If yes, steps 1704-1710 are repeated. For example,the ophthalmic system may scan across multiple regions of the eye, so asto test and receive inputs 1710 related to the entire surface of theeye. The number of regions of the eye (e.g., a step size between eachtest), which region has been tested, and which regions remain to betested, along with the order of the testing, may be stored in thedigital memory of local processing module (70) and/or remote datarepository (74). For example, the optical prescription of each regionmay be defined by the received inputs at 1710, and these regions may bemapped to the anatomy of the eye based on imaging the eye by inwardfacing cameras (e.g., cameras (24)). The number of regions may be anynumber, for example, one (e.g., center, peripheral, or there between),two regions (e.g., center and a single peripheral) or more regions. Thelocal processing module (70) may retrieve this information so as todetermine which region is to be tested next or if any regions remain tobe tested. Thus, the ophthalmic system may carry out steps 1704-1710 foreach of the multiple regions of the eye.

After all the regions are tested, the ophthalmic system, at 1714,analyzes the received inputs for each region to determine any visiondiscrepancies. For example, inputs for each region of the eye may beindicative that a particular region suffers from refractive errors,cataracts, macular degeneration, central lens defects, amblyopia, etc.,as described above and throughout this disclosure. This may beperformed, for example, by comparing the user's responses to historicaldata (for example, from previous testing performed by the ophthalmicdevice) about the user, in one or more embodiments. This may be anindication that the user's vision is deteriorating. Or, in otherembodiments, the data may be compared to standard data, or typicalresponses of individuals of a particular age group. Similarly many suchapproaches and corresponding algorithms may be used to analyze thereceived data. Pattern recognition may be use in various embodiments.The received data may be stored in the digital memory, and the localprocessing module (70) may execute instructions to perform algorithms toanalyze the received data.

FIG. 17F is an exemplary process flow for correcting vision defects. Insome implementations, the ophthalmic system may be configured to apply apinhole occluder to the display device (62) to correct for visiondefects of the user. For example, if a user having refractive errors inone or more regions of an eye views the world through pinhole occluder,the user's vision may be improved. In another implementation, theophthalmic device may be configured to apply multiple pinholes (e.g.,pinhole glasses, stenopeic glasses, etc.) to the display device, whichmay or may not function at least partially as field stops (e.g.,occluding extraneous light rays), as described above. Withoutsubscribing to any scientific theory, such configurations may result inimproved focusing of an image by the eye. The size and number of holesmay be adjusted and determined, for example, based on the visual defectsof the user and/or by trying different configurations or otherwisedetermined. FIG. 17E schematically illustrates such a configuration asviewed through the multiple pinhole occluder. The user may view scene(1720) through display device (62) and occluder (1730 c) having multiplepinholes (1735 c). Without subscribing to any particular scientifictheory, in some cases this may stop down light rays that interact withvision defects in the eye of the wearer, thereby improving vision.

Referring now to FIG. 17F, an example process flow for therapeuticallycorrecting vision defects (e.g., refractive errors, cataracts, maculardegeneration, central lens defects, etc.) by using a pinhole occluder isbriefly discussed. The process flow 1760 is directed to modifying animage presented to the user based on a prescription of the user. In someembodiments, process flow 1760 may be performed by patient-wornophthalmic devices, such as those described in connection with FIGS.3A-3D. The process flow 1760 can be implemented by the local processingmodule (70) configured to execute logic devices in the local processingmodule (70).

At 1762, the ophthalmic system may determine, retrieve, or receive anoptical prescription of a user. As described above, the ophthalmicdevice may include a user interface whereby the user inputs an opticalprescription or the ophthalmic system may go through an eye-prescriptionconfigurator program to determine vision defects. For example, theprocess flow 1700 may be one input used to define an opticalprescription. Other methods of determining vision defects are possible,for example, as described throughout this disclosure. In someembodiments, the ophthalmic system may be configured to receive anoptical prescription from a third party. For example, a doctor may beable to send a user optical prescription wirelessly (e.g., over theinternet, Bluetooth connection, etc.), which is received by a receiveror transceiver and stored in the digital memory of the local processingmodule (72).

In another embodiment, the ophthalmic system may automatically (andpossibly incrementally) change the user's prescription based on feedbackfrom the eye tracking system. As described above, the system maydetermine a user is struggling to view an object or image. For example,as described above, if a user's eyes are shifting, unstable,oscillating, changing (e.g., in an unsteady or random manner)accommodation, etc., as measured, for example, by monitoring thevergence, pupil size, and lens shape or movement as described herein,these may be indicators that the user is unable to comfortably view theobject. In response, the system may initiate an eye prescriptionconfigurator program.

In some embodiments, the ophthalmic system may be configured to receivean optical prescription from a third party. For example, a doctor may beable to send a user optical prescription wirelessly (e.g., over theinternet, Blue-tooth connection, etc.), which is received by a receiveror transceiver and stored in the digital memory of the local processingmodule (70).

At 1764, the ophthalmic system determines occluding requirements of theeye. Occluding requirements may refer to the number of pinholes, thearrangement of the pinholes, or the size of the pinholes. In variousembodiments, the occluding requirements may be based on the opticalprescription of the user. For example, in some embodiments the localprocessing module (70) may retrieve, from a digital memory, acorrelation of the vision discrepancies and defect regions of the eyesfrom step 1714 of FIG. 17D. Based on this information, the localprocessing module (70) may execute instructions to determine where oneor more pinholes should be placed and the size of the pinholes tocorrect for these discrepancies.

At 1766, the ophthalmic system may obtain inputs from the user's eyeand/or the ambient light from the world surrounding the user (e.g.,“real-time information”) and the ophthalmic system via outward facingcameras. The ophthalmic system may, for example, receive these inputsfrom one or more sensors configured to detect an intensity of ambientlight from the surrounding world in real-time. These sensors maycomprise, for example, the sensor assembly (39), the eye trackingsystem, and/or the outward facing cameras (e.g., cameras (16)). Theseinputs may be stored in the digital memory of the local processingmodule (70) for subsequent retrieval and processing operations.

In another embodiment, gaze orientation may be an example of theobtained inputs. Gaze orientation may be determined by sensor assembly(39) and/or eye tracking system. The sensors may determine that whetherthe gaze orientation of a user has changed relative to a perviousorientation. For example, the eye tracking system may monitor eyemovements. For example, if the wearer's head is tilted forward anddownward, and/or the wearer's eyes are tilted downward, the wearer maybe looking at an object such as a book or may be looking at projectedimage content corresponding to images placed in a location (lower partof field of view) typically associate with nearby objects. The gaze mayalso be used to determine the vergence of the eyes, how the lines ofsight of the pair of eyes converge on a location and how far thatlocation is with respect to the wearer. By monitoring the vergence(e.g., as described in FIG. 6), the gaze orientation at which the vieweris intending to view an object may be determined.

Another example of input at 1766 may be ambient light from theenvironment surrounding the user. In this respect, the ophthalmic systemmay also include outward facing cameras (e.g., cameras (16)) to measurethe surrounding ambient light intensity. In another embodiment, thelocal processing module (70) may be configured to determine a time ofdate, which may be indicative of a light intensity value (e.g., lightlevels may be lower during the evening as compared to during the day).

At 1768, the ophthalmic system may modify the occluding requirementsbased on the obtained inputs from 1766. For example, the localprocessing module (70) may retrieve one or more inputs stored in 1766from the digital memory and adjust the size, shape, and arrangement ofthe pinhole occluder.

In some embodiments, ambient light levels detected by outward facingcameras may be retrieved by the local processing module (70) andutilized as an input to determine whether to adjust an aperture stop ofthe optics of display device (62). For example, where the ophthalmicsystem detects low levels of ambient light in front of the user usingoutward facing cameras, the local processing module (70) may executeinstructions to increase the aperture stop of the display lens (106),thereby increasing the intensity of the light projected to the user bythe ophthalmic system. Conversely, where the system detects high levelsof ambient light in front of the user, the local processing module (70)may cause the aperture stop to be decreased, to stop down the lightprojected to the user.

In various embodiments, the ophthalmic system may be configured tomodify the pinhole occluder requirements (e.g., the size, shape,arrangement, etc. of the pinholes) based on other inputs from thesurround world. For example, the ophthalmic device may be configured todetermine that the user is viewing an object by, for example, utilizingthe sensor assembly (39), eye tracking system, or outward facing cameras(e.g., cameras (16)) to detect near-field accommodation of the eyes, asdescribed above. When viewing an object in the near-field, the user mayrequire higher intensity or more light from the object being viewed andless from the surrounding environment. If the user has a dead or weakspot in the central viewing region of the eye, the ophthalmic system maybe configured to apply a central pinhole to stop down peripheral ambientlight from the surrounding world in front of the user, while increasingthe contrast of the light from the viewed object. In another embodiment,if the occluding requirements include multiple pinholes, the pinholeoccluder may be configured to defocus the peripheral region, forexample, of the image content projected into the eye by the displaydevice.

At 1770, the occluding characteristics may be applied to one or moreimages to be projected to the user's eyes. In some embodiments, thedigital memory or remote data repository (74) may be configured to storeimage content (e.g., AR and/or VR image content, as described above).The local processing module (70), either independently or incommunication with remote processing module (72), may be configured toretrieve this image content and execute instructions to generate apinhole occluder to occlude the image displayed to the user by theophthalmic system and/or ambient light passed to the user from in frontof the ophthalmic system based on the occluding requirements.

At 1772, the occluded images are projected to the user such that theuser views the images comfortably. For example, the ophthalmic systemmay project light (38) to the user to form an image in the eye of theuser. The image may be an occluded image based on a physical ormechanical pinhole occluder such as one or more spatial light modulatorsto occlude an unmodified image. In another embodiment, alternatively orin combination, the 2D image generated by the ophthalmic system may beoccluded digitally by not showing portions of the image that are to beblocked based on software executed in the local processing module (70)and then displayed through display device (62).

In some embodiments, at 1772 the ophthalmic system may implement dynamicvision correction by initiating an eye-prescription configuratorprogram. At 1772, the ophthalmic system can be configured to return toblock 1762 and manually and interactively determine the user'sprescription at each interval, in some embodiments, without useractivation. For example, the ophthalmic system may monitor the viewingcomfort of the user, and automatically and possibly incrementally adjustthe prescription and/or vision correction where the user is unable tocomfortably view images presented them. For example, as described above,the ophthalmic system may utilize the eye tracking system (e.g., cameras(24)) to determine whether a user is struggling to view an image basedin part on shifting, instability, oscillating, abnormal, and/orinvoluntary fluctuations in eye movement, pupil size, vergence,accommodation, and/or gaze orientation. Where struggle is determined,the ophthalmic system may initiate an eye-prescription configurationprogram to determine a new optical prescription and/or adjust the visioncorrection (e.g., modify the pinhole occluder requirements). In someembodiments, when struggle is determined, the ophthalmic system mayalert the user of such or the ophthalmic system may perform other typesof tests such as described herein.

In some embodiments, where the ophthalmic device is an augmented realityhead-mounted display system, pinhole occlusion may be applied to animage to be presented to the wearer while imaging objects located infront of the head mounted display and the user. For example, AR imagecontent presented by the ophthalmic system may be occluded and projectedin combination with ambient light. In some embodiments, AR image contentmay include the ambient light passing from the outside world through thelens (106), and such ambient light may also be occluded to provideoptical compensation for a wearer viewing the outside world through thelens (106). In another embodiment, in the case of a VR head mounteddisplay system that is opaque to the world in front of the user, theoccluded image may be an occlusion one or more regions of a VR imageprovided by the ophthalmic system and the display therein for visualrepresentation, for example, a VR image content.

Initial W4LT Test

Another test that may be administered through the ophthalmic systemsdescribed herein is the Worth Four Light Test or Worth Four Dot Test(either referred hereinafter as “W4LT”). W4LT assesses a patient'sdegree of binocular vision and binocular single vision. Binocular visioninvolves an image being projected by each eye simultaneously into asingle image in the forward field. The W4LT can detect the suppressionof either the right or the left eye. Suppression may occur during thebinocular vision when the brain does not process information receivedfrom either of the eyes. This is a common adaptation to strabismus,amblyopia (discussed above), and aniseikonia (each eye perceives animage as a different size).

Traditionally, with W4LT testing, the patient wears red-green goggles(usually a red lens over the right eye and a green lens over the lefteye). The test can be performed either close to the patient or far awayfrom the patient, and both provide different assessments of thepatient's vision. When performed at a far distance, the W4LT instrumentis composed of a wall-mounted box with four lights arranged in a diamondconfiguration with a red light at the top, two green lights at eitherside, and a white light at the bottom. When performed at a neardistance, the same configuration of lights is arranged in a hand heldinstrument similar to a flashlight.

Because the red filter blocks the green light and the green filterblocks the red light, it is possible to determine if the patient isusing both eyes simultaneously in a coordinated manner. With both eyesopen, a patient with normal binocular vision will perceive four lights.If the patient either closes or suppresses an eye, they will see eithertwo or three lights. If the patient does not fuse the images of the twoeyes they will see five lights (diplopia, commonly known as doublevision).

The ophthalmic system may be programmed to administer the W4LT test byproviding depth cues with near-field glasses by presenting each eye withan independent image that is to be converged at a distance. These imagescan be colored dots similar to the W4LT test or any other suitable pairof images. For example, the pair of images can include colored dots,colored symbols, polarized images, colored features, polarized features,colored icons, polarized icons, colored objects, polarized objects, orthe like. The responses of the user may be recorded, and analyzed todetermine if the user has any vision defects. The results can bereported back to the clinician or patient.

In some embodiments, a wearable augmented reality device can be used asan ophthalmic system to administer a vision test by projectingindependent left and right images to left and right eyes of the wearer.This vision test can be W4LT or other similar vision testing program.The ophthalmic device can use the results of the vision test to identifyvision defects. For example, the ophthalmic device can use the resultsof the vision test to assess the wearer's degree of binocular vision andbinocular single vision (e.g., whether the wearer suffers from diplopiaor double vision). As another example, the ophthalmic device can use theresults of the vision test to determine suppression of either the rightor left eye of the wearer. The augmented reality device can beconfigured to present different images to the left and right eyes, toreceive user input regarding what is perceived by the wearer when theimages are presented, and to determine a vision defect based on thereceived user input. The augmented reality device can be configured topresent different images to the left and right eyes, to automaticallyassess what is perceived by the wearer when the images are presented,and to determine a vision defect based on the automatic assessment. Itshould be appreciated that such a system may be used to test and/ortreat the eyes of the wearer, and this may typically occur at a doctor'sor clinician's office. In one or more embodiments, the patient'sindividual ophthalmic system may be used, possibly with doctorsupervision, or the doctor's office may have its own version of theophthalmic system that may be used for testing and/or treatment. In someembodiments, the eyewear perform tests periodically (or aperiodically),but a number of times over a period of one or more days, months, oryears and record the results. In some embodiments, the eyewear alertsthe wearer to let the wearer know that it may be an appropriate time toperform a test. The system can monitor historical changes in the testresults and thereby identify any problem such as deterioration in visionor other heath problem.

The wearable augmented reality device includes an augmented realitydisplay platform configured to project images into respective left andright eyes of the wearer. The display platform can be configuredsimilarly to the display lens 106, as described herein in greater detailwith reference to FIG. 5. The display platform can include left andright displays respectively for the left and right eyes of the wearer.In some implementations, the display platform can also be configured topass light from the world or environment beyond the eyewear through thedisplay platform (e.g., a lens and/or adaptive optics elements in thefront thereof) to the eye of the wearer. In this way, the wearer can seeimages projected with the display platform superimposed with what thewearer can see in the world.

In some embodiments, the wearable augmented reality device includes thedisplay platform described above and at least one light sourceconfigured to project light into the eye of the wearer. The at least onelight source can be configured to project light into the eye of thewearer to form an image in the eye. In some embodiments, the at leastone light source includes a fiber scanning display, as described ingreater detail elsewhere herein. The fiber scanning display inconjunction with adaptable optics, for example varifocal opticalelement, can be configured to display or transmit light from one or moredepth planes and/or to vary the depth plane. In some embodiments, a testcan be performed by projecting images from a distant depth plane (e.g.,about 6 m from the wearer) and/or from a near depth plane (e.g., about0.33 m from the wearer).

In some embodiments, the display platform includes a waveguide stack, asdescribed in greater detail elsewhere herein. The waveguide stack can beconfigured to project light from different focal planes. In certainimplementations, the waveguide stack includes one or more lenses in thestack, as described in greater detail elsewhere herein. The waveguidestack can be configured to display or transmit images from one or moredepth planes. In some embodiments, the display platform includesadaptable optics elements configured to project light or images fromdifferent depth planes. In certain implementations, the adaptable opticselements include variable focus elements (VFEs), as described in greaterdetail elsewhere herein.

The wearable augmented reality device can include one or more userinterface features configured to allow a wearer or other person toprovide input to the device. The user interface features can beintegrated with the device. In some implementations, the user interfacefeatures are provided by a device or component that is not physicallyintegrated with the device. For example, the user interface features canbe provided by a device or system that is in communication with thedevice. This can be a smartphone, computer, tablet, or othercomputational device that is in wired or wireless communication with thedevice. In some embodiments, the user interface features can be providedby a combination of different devices and systems linked to the device,e.g., through wired or wireless communication networks or throughcomponents that are physically linked to the device or integrated withthe device. In various embodiments, the user interface comprises voicerecognition or a virtual touch display. The user interface features canalso be presented on a device with a touch screen wherein interactionwith the touch screen provides input to the wearable augmented realitydevice. Accordingly, the user interface features can include capacitivefeatures sensitive to touch, keyboards, buttons, microphones, cameras,motion sensors, photodetectors, or a variety of software-implementedfeatures provided by a graphical user interface. In some embodiments,the user interface includes one or more features or sensors configuredto capture gestures of the wearer to provide input. In variousembodiments, a virtual touch screen is provided through the imagesprojected to the user's eyes and sensors to sense the users moving body,e.g., finger. In some embodiments, the user interface features includegesture detection components to allow a wearer to provide user inputthrough gestures. In some embodiments, the user interface featuresinclude gaze detection components to allow a wearer to provide userinput through gaze of the eyes (e.g., this can include selecting abutton or other element when the wearer fixates on the button for a timeor when the wearer blinks when fixated on the button). Such userinterface systems can be employed for other devices and systemsdescribed herein.

In some implementations, the wearer, clinician or doctor can use theinterface features to control aspects of the W4LT. This can be done, forexample, to change the depth plane of the projected images, to modifycharacteristics of the projected images, or to otherwise configuretesting of binocular vision.

FIG. 18 illustrates an example method 1800 of administering a Worth FourLight Test or Worth Four Dot Test to assess the wearer's degree ofbinocular single vision. For ease of description, the method 1800 willbe described as being performed by an ophthalmic system, such as any ofthe augmented reality devices described herein. However, it is to beunderstood that any component or subpart of the various augmentedreality devices disclosed herein or other similar devices can be used toperform any step, combination of steps, or portions of a step in themethod 1800.

At block 1802, the ophthalmic device initiates a W4LT program. The W4LTprogram can be a stored process or sequence of functions provided by theophthalmic system. Initiating the W4LT program can include determiningor retrieving a starting depth plane or sequence of depth planes for theprojected images. In some implementations, the W4LT program canintegrate information about ocular anomalies of the wearer's eye(s),where the information about the ocular anomalies can be entered by thewearer or clinician, determined from a previous eye test program, orretrieved from a data store (e.g., a data store that is part of theophthalmic system or a networked data store). Initiating the W4LTprogram can include determining the image or sequences of potentialimages to be projected to the wearer. Initiating the W4LT program caninclude determining whether a clinician or doctor is administering theeye exam or whether the examination is being self-administered by thewearer. In some embodiments, the ophthalmic system initiates the W4LTprogram in response to input received from the wearer or a clinician. Insome cases, the system initiates the W4LT test based on a predeterminedprotocol or because the system senses deterioration in eyesight.

At block 1804, the ophthalmic system presents a virtual image to one ofthe eyes (e.g., a set of colored dots to the right eye), and at block1806, the ophthalmic system presents another virtual image to the othereye (e.g., a complementary set of colored dots to the left eye). Forexample, the ophthalmic system can project a left image to the left eyeusing a left display and a right image to the right eye using a rightdisplay. The right image and left image can include elements that arecoincidental (e.g., that would be aligned when viewed by a person withnormal binocular single vision). The right image and left image caninclude elements that are unique and misaligned (e.g., that would beperceived as being in different locations by a person with normalbinocular single vision). The right image and left images can includecolored dots, colored features, colored objects, colored icons, or othersimilar elements. Similarly, the right display and the left display canbe configured to project polarized images (e.g., dots, features,objects, icons, etc.). The ophthalmic system can be configured toproject independent images to the respective eyes of the wearer, whereinthe independent images are configured to be viewed differently anddistinctly by people with binocular singular vision, diplopia, and/orsuppression of one eye. In some embodiments, the ophthalmic system canbe configured to project independent images to the respective eyes ofthe wearer wherein the images are projected from different depth planes.

At block 1808, the system may receive input from the user regarding aconvergence of both images, through some kind of user interface such asthe user interfaces described herein. In some embodiments, theophthalmic system can be configured to present a number of options forselection by the wearer. The options can correspond to different imagesthat correspond to results of viewing the projected images by personswith regular vision or with vision defects. For example, if the imagespresented to the wearer correspond to the 4 dots of the W4LT, images canappear to the wearer that have 4 dots, 5 dots, 3 dots, 2 dots, etc.depending on the state of their health, e.g., the heath of their eye andoptical pathway. The ophthalmic system can receive user input indicatingwhich of the presented images corresponds to what the wearer perceivedwhen viewing the projected images. In some embodiments, the ophthalmicsystem can receive other indicators from the wearer indicative of whatthe wearer perceived. The indicators can include words, colors, numbers,sizes, locations, etc. corresponding to the image the wearer perceived.

In some embodiments, the ophthalmic system is configured to objectivelydetermine convergence of both images. For example, the system can beconfigured to monitor the image projected onto the retina. By comparingthe projected images on the retina, the system can be configured tomatch them and to determine whether the images are aligned on the samesection of the retina. Where the images are aligned, the system canautomatically determine that the wearer has normal or correct vision.Where the images are misaligned, the system can automatically determinethat the wearer has double vision. In some implementations, the systemis configured to monitor the alignment of images in the eyes of thewearer. If the system determines that the images are misaligned, thesystem can generate an alert or initiate an eye test.

At block 1810, the ophthalmic system analyzes the received input andidentifies vision defects of the user. In some embodiments, theophthalmic system is configured to identify a degree of binocular visionor binocular single vision. In some embodiments, the ophthalmic systemis configured to identify a degree of diplopia, esotropia, exotropia,hypotropia, hypertropia, etc. In some embodiments, the ophthalmic systemis configured to identify suppression of the right or left eye. Theophthalmic system can be configured to compare the received input withthe projected images to determine the vision defects. The ophthalmicsystem can be configured to compare the alignment of images on theretina of the wearer to automatically determine vision defects. Theophthalmic system can be configured to compare the received input withthe depth plane information for the projected images to determine thevision defects.

In some embodiments, the ophthalmic system is configured to initiatetesting, returning from block 1810 to 1802, when the system determinesthat the wearer is struggling to focus or experiencing vision troubles.This is represented by the dotted line from 1810 to 1802.

In various embodiments, to reduce distraction, the view of the world infront of the wearer's eyes through the augmented reality device isblocked or otherwise not visible during the examination. This can occur,for example, when images are presented to the viewer, although thisapproach is not necessary. In some embodiments, to block ambient lightfrom the outside world in front of the lens from reaching the eye, thesystem may include one or more spatial light modulator, such as liquidcrystal arrays that can be switched so as to block varying amountslight.

Although the system has been described as an augmented reality device,in other embodiments the system may be a virtual reality device. Ineither case, the ophthalmic system may be a device provided by thephysician or clinician for testing at a medical facility or optometristoffice or elsewhere. In other embodiments, the ophthalmic system maybelong to the wearer and may be employed for other purposes such asentertainment (e.g., games and movies) and/or work activities. Asdescribed above, one benefit of implementing the examination on thewearer's system is that the examination can be conveniently undertakenmultiple times (at least 2, 3, 4, 5, 6, 8, 10, 12, 16, 18, 24, or moretimes) throughout the year. The system can also record historical datarelating to previous tests and evaluate the change in data over time. Insome embodiments, the frequency or schedule of examination can bealtered based on results and/or trends of test results. For example, ifthe test results indicate that vision defects are deteriorating or thatthe wearer is struggling more to focus on an image (e.g., accommodationfluctuations, vergence fluctuations, squinting in one eye, etc.), thefrequency or schedule of the procedure can be altered to increase thefrequency of procedures and/or shorten the time between procedures.Likewise, the examination can be performed with or without a medicalprofessional, such as optometrist, ophthalmologist, nurse, technician,medical assistant etc.

Retinoscopy

The wearable augmented reality (or virtual reality) devices describedherein can be used as an ophthalmic system to function as a retinoscopeto determine vision defects of a wearer or a patient. In particular, theaugmented (or virtual) reality device can be used to detect myopia,hyperopia, astigmatisms, and/or other vision defects when operating as aretinoscope. The augmented (or virtual) reality device can be configuredto determine, for example, a refractive error of an eye of a patient byusing retinoscopy techniques, such as neutralization. Neutralizationincludes adjusting refractive power in front of an eye until a lightbeam or spot swept across the eye forms an image at the retina thatsubstantially ceases to move across the retina. The augmented (orvirtual) reality instrument may be configured to provide beams withdiffering optical correction until neutralization is achieved. Theaugmented (or virtual) reality device can thus be configured todetermine an optical prescription to correct identified vision defects.It should be appreciated that such a device may be used to administer aneye exam, and this exam may typically be administered at a doctor's orclinician's office or at a home by the wearer automatically. In one ormore embodiments, the patient's individual ophthalmic system may beused, possibly with doctor supervision, or the doctor's office may haveits own version of the ophthalmic system that may be used for diagnosticpurposes. In various embodiments, this augmented (or virtual) realitydevice can be configured similarly to the devices disclosed herein.

In some embodiments, the wearable augmented (or virtual) reality devicemay be used to perform retinoscopy to identify vision defects usinglight that is swept across a wearer's eye. Examples of devices that canbe configured to perform retinoscopy are described herein and include,for example and without limitation, the devices described herein withreference to FIGS. 5, 10D, 10E, 22A, and 22C. The wearable augmented (orvirtual) reality device includes an augmented reality display platformconfigured to project a beam of light into the eye of a wearer. Thedisplay platform can be configured similarly to the display lens 106, asdescribed herein with reference to FIG. 5, or other display systems orplatforms described herein (e.g., display systems 62, 2062, 2262, 23622462, 2662 respectively described herein with reference to FIGS. 5, 20A,22A, 23B, 24A, 24C, and/or display platform 1402 in FIG. 14). In someimplementations, such as for augmented reality devices, the displayplatform can also be configured to pass light from the world orenvironment through the display platform (e.g., a lens in the frontthereof) to the eye of the wearer. In this way, the wearer can seeobjects in the world in front of the wearer and can potentially fixateon distant or near objects depending, for example, on the type ofretinoscopy test. The focus of the beam projected into the eye can bevaried or otherwise provided with optical correction. As such, thewearable augmented reality device can be configured to performretinoscopy to measure refractive error of an eye of a wearer.

In some embodiments, the wearable augmented reality device includes thedisplay platform described above and at least one light sourceconfigured to project light into the eye of the wearer. Example lightsources suitable for this purpose are described in greater detailherein, such as light source 2268 described herein with reference toFIG. 22A and/or the light source described herein with reference to FIG.22C. This light source, which may include wave guides, may augment thedisplay light source and corresponding wave guides (e.g., wave guidestack) employed to project images into the wearers eye to provideaugmented reality or virtual reality content. The at least one lightsource used for retinoscopy can be configured to provide a light beamthat is swept across the eye of the wearer. In some embodiments, thewearable augmented reality device also includes a sensor configured tomeasure light reflected from a retina in response to the light beam fromthe at least one light source being swept across the eye of the wearer.In various embodiments, the sensor images the eye. This sensor maycomprise an eye tracking sensor or other inward facing optical sensor orcamera that is configured to be directed to the eye, for example, toimage the eye. The wearable augmented reality device can be configuredto perform retinoscopy to measure refractive error of the eye of thewearer. For example, the augmented reality device can be configured tosweep the light beam across the eye of the wearer in one or moredirections, to detect, measure, or image the reflection, or reflex, fromthe back of the eye of the wearer (e.g., the retina, the ocular fundus,etc.), and to determine vision defects through observation ormeasurement of the reflex. Optical correction can be introduced to thelight beam and the reflex can be observed to determine when such opticalcorrection is sufficient to offset the wearer's refractive error.

The at least one light source can be configured to provide a light beamthat is moved across or around an eye of the wearer of the augmentedreality device. In certain implementations, the at least one lightsource provides a relatively narrow beam or strip of light that is movedacross the eye. The beam of light may have a cross-section orthogonalthe direction of its optical path that is elongate, wherein thiscross-section is longer in one direction than a perpendicular direction.Accordingly, the beam comprises a strip in certain embodiments. Thelight provided by the at least one light source can be configured to bemoved in one or more directions. When the light provided by the at leastone light source is a relatively narrow beam or strip of light, theorientation of the beam or strip of light can be changed. Thus, the atleast one light source can be configured to provide light that can beused to identify myopia, hyperopia, astigmatism, pigment, age-relatedmacular degeneration, and other vision defects.

The sensor can be configured to sense light reflected from the back ofthe eye or retina of the wearer (e.g., retinoscopic reflex, ret reflex,or reflex) of the augmented reality device, and in various embodimentsform an image the eye. Accordingly, the sensor can be an image sensor orcamera, one or more photodetectors, or other device that can provide asignal in response to detected light and possibly an image of the eye.In some embodiments, the sensor can include one or more filters tailoredto preferentially pass (e.g., bandpass filters tuned to pass bands ofwavelengths that are expected for the reflex) the reflex from the eye ofthe wearer and to preferentially block light in other wavelength bands.The filters can be physical filters and/or filters applied in signal orimage processing software.

The at least one light source and the sensor (e.g., camera) can becoupled to a control system that is configured to process informationabout the characteristics, direction, orientation, and/or position ofthe light provided by the at least one light source and to processinformation about the characteristics, direction, orientation, and/orposition of the light detected by the sensor. From this information, thecontrol system can be configured to determine one or more vision defectsof the eye of the wearer. In some embodiments, the control system can beconfigured to modify the light provided by the at least one light source(e.g., the direction, orientation, as well as optical correction provideto the beam etc.) based at least in part on analysis of the lightdetected by the sensor. In some embodiments, the control system isconfigured to perform a pre-defined routine to determine vision defects.In some embodiments, the control system can adapt a retinoscopy routinebased on results of analysis of the light detected by the sensor at anypoint during the routine.

The augmented reality system can be configured to project images to thewearer. As described herein, the augmented reality system can provideimages to the wearer corresponding to different depth planes, both farand near. Accordingly, the wearer can fixate on the display, looking atimages that simulate far and near objects. In this manner, the wearercan have either relaxed accommodation or may exhibit accommodationdepending on the test.

The augmented reality system can thus be configured to provide staticand/or dynamic retinoscopy. For static retinoscopy, for example, theaugmented reality device can be configured to determine refractiveerrors when the wearer has relaxed accommodation. For dynamicretinoscopy, for example, the augmented reality device can be configuredto perform retinoscopy while the wearer accommodates at differentdistances. This can be accomplished by providing virtual images orobjects on which the wearer focuses while performing retinoscopy. Thedistance to the image or object can be changed while accommodation ofthe eye is tracked through the methods and systems described herein.Distance to the image can be changed by varying the depth plane of thedisplay device, for example in a manner such as described herein. Forexample, lenses associated with a waveguide stack through which light isprojected to form an image may have an optical power that provides for aspecific focal length and associated depth plane. Illustrative andnon-limiting examples of this configuration are provided herein in thedescription of waveguide stacks and lenses with reference to FIGS. 10Dand 10E. The distance from the eye to the depth plan can thus be known.In some cases, such lenses or other optical element that project thebeam, have variable optical power that can be selected or adjusted, forexample, by applying an electrical signal thereto. Accordingly the depthplanes can be changed or adjusted as desired in such cases.Alternatively, or in addition, distance to an object can also be changedby placing an actual object in the world in front of the wearer andwithin the field of view of the wearer that is seen through the displayplatform of the augmented reality device, as described herein. Either ofthese approaches can be used to determine, for example, the wearer'saccommodative response to changes in target distance. These approachescan also be used to determine, for example, the eye's near point. Thiscan be compared to static retinoscopy that determines, among otherthings, the eye's far point.

In some embodiments, the at least one light source includes a fiberscanning display, as described herein. In some embodiments, the at leastone light source includes a fiber scanning display and a lightgenerating source. The fiber scanning display can be configured toprovide different depth planes from which the light beam, can beprojected. The fiber scanning device can thus provide different amountsof sphere to determine a suitable optical correction for the wearer. Invarious embodiments, the fiber scanning display can be configured tosend or transmit light towards an eye of the wearer and to collect orreceive light reflected from the eye. The fiber scanning display can beconfigured to sweep or move the light across or around the eye of thewearer. The fiber scanning display can be configured to display ortransmit light from one or more depth planes. In certainimplementations, the fiber scanning display can be configured to haveone or more fibers for generating or distributing light and forreceiving light reflected from the eye of the wearer. In variousimplementations, one or more fibers of the fiber scanning display areconfigured to generate or distribute light and one or more differentfibers are configured to receive light reflected from the eye of thewearer. The fiber scanning display can include multi-mode fiber in someembodiments. An example of this is described herein with reference tomulticore fiber 362 illustrated in FIG. 28B.

In some embodiments, the display platform includes a waveguide stack, asdescribed above and elsewhere herein. The waveguide stack can beconfigured to project light from different focal planes. In certainimplementations, the waveguide stack includes one or more lenses orother elements (e.g., reflective, diffractive, etc.) with optical powerin the stack, as described herein.

In some embodiments, the display platform includes adaptable opticselements configured to project light to different or targeted portionsof the eye of the wearer. In certain implementations, the adaptableoptics elements include variable focus elements (VFEs), as describedabove and elsewhere herein. Illustrative and non-limiting examples ofthis are described herein with reference to FIGS. 10B, 10C, and/or 10E.In some embodiments, the variable focus elements include a membranemirror. The membrane mirror can include one or more electrodes on themirror and a control system that is configured to control the one ormore electrodes to modify a shape of the membrane mirror. Other types ofadaptable optics and VFEs may be employed. The adaptable optics or VFEscan provide optical correction such as different amounts and directionsof sphere and/or cylinder (and axes) that can be tested vianeutralization using retinoscopy.

In some embodiments, the wearable augmented reality device includes acamera that is part of the display platform. The camera may be coupledto the waveguides that provide different depth planes. Accordingly, incertain implementations, the ophthalmic system can be configured toproject light from a first depth plane and to measure the reflex at asecond depth plane different from the first. Illustrative andnon-limiting examples of such an image acquisition system are describedherein with reference to FIG. 22C.

The wearable augmented reality device can include one or more userinterface features configured to allow a wearer or other person toprovide input to the device. The user interface features can beintegrated with the device. In some implementations, the user interfacefeatures are provided by a device or component that is not physicallyintegrated with the device. For example, the user interface features canbe provided by a device or system that is in communication with thedevice. This can be a smartphone, computer, tablet, or othercomputational device that is in wired or wireless communication with thedevice. In some embodiments, the user interface features can be providedby a combination of different devices and systems linked to the device,e.g., through wired or wireless communication networks or throughcomponents that are physically linked to the device or integrated withthe device. The user interface features can be presented on a devicewith a touch screen wherein interaction with the touch screen providesinput to the wearable augmented reality device. Voice recognitionsystems as well as virtual touch capability may be included in additionor as an alternative. Accordingly, the user interface features caninclude capacitive features sensitive to touch, keyboards, buttons,microphones, photodetectors, cameras or tracking sensors for trackinggestures such as pointing by the wearer or a variety ofsoftware-implemented features provided by a graphical user interface. Invarious embodiments, a virtual touch screen is provided through theimages projected to the user's eyes and sensors to sense the usersmoving body, e.g., finger. In some embodiments, the user interfacefeatures include gesture detection components to allow a wearer toprovide user input through gestures. In some embodiments, the userinterface features include gaze detection components to allow a wearerto provide user input through gaze of the eyes (e.g., this can includeselecting a button or other element when the wearer fixates on thebutton for a time or when the wearer blinks when fixated on the button).Such user interface systems can be employed for other devices andsystems described herein.

In some implementations, the wearer, clinician or doctor can use theinterface features to control aspects of the retinoscopy test. This canbe done, for example, to change the characteristics of the image orlight being provided and/or the depth plane from which the light orimage is being projected. This can be used to alter the light andoptical correction being provided to the wearer to determine anappropriate optical prescription for the wearer.

In some embodiments, the ophthalmic device (e.g., augmented or virtualreality device) may be configured to provide both static and dynamicretinoscopy. Since the focus of images can be dynamically modifiedthrough adaptable optics elements (e.g., VFEs) of the ophthalmic device,both types of retinoscopy may be performed with the same device. Itshould be appreciated that the ophthalmic device may also provide astatic or swept path of light to the retina. This may be a light beamprojected by a light source such as a FSD (fiber scanning display) or alight generating source of the ophthalmic device. In someimplementations, the ophthalmic device may comprise an additional acomponent that is configured to sweep light across the retina orotherwise move light on the retina. The augmented reality device can beused to perform retinoscopy and objectively determine refractive errors,which may be advantageous over other instruments that use subjectivefeedback from patients to determine refractive errors.

To provide static retinoscopy, the augmented reality device is used whenthe accommodation of the eye of the wearer is relaxed. This can beaccomplished, for example, through the use of cyclopegic drops in theeye of the wearer. A light spot or beam can be provided and moved acrossthe eye of the wearer. Lenses and/or refractive corrections or othercomponents that can alter the shape of the wavefront can be applied toneutralize or compensate for vision defects. Adaptive optics or VFEsincluding reflective, diffractive, and/or refractive may be employed. Insome embodiments, when operating as a static retinoscope, an imageprovided by the augmented reality device for the view used to fixate canbe provided from a depth plane that is far, e.g., effectively atinfinity. In some embodiments, when operating as a static retinoscope,the light provided by the augmented reality device that is swept acrossthe eye can be provided from a static depth plane. The depth plane fromwhich the virtual image is projected can be placed between infinity andabout 0.1 m. In certain implementations, the augmented reality deviceincludes a spray or other delivery device to deliver eye drops or aspray used to dilate the pupil and/or relax accommodation of the eye ofthe wearer. For example, the augmented reality device can be configuredto spray cycloplegic drops in the eye of the wearer.

To provide dynamic retinoscopy, the augmented reality device can be usedwhen the eye of the wearer is allowed to accommodate. An image can bedisplayed to the wearer or an object can be provided for the wearer tofixate on. The distance of the image or object can be varied so as toinduce accommodation. In some embodiments, the accommodation of the eyeof the wearer can be observed and/or measured. Using this technique,accommodation lag or lead may be measured.

The augmented reality devices described herein can be used to switchbetween static retinoscopy and dynamic retinoscopy. This can beaccomplished while the augmented reality device is in use. The augmentedreality device can be configured to provide images from a variety ofdepth planes for the wearer to view, allowing both static and dynamicretinoscopy to be performed. For example, the image provided by theaugmented reality device can be dynamically modified to switch betweenstatic retinoscopy and dynamic retinoscopy.

As was the case in previous embodiments, input may be received by thewearer to determine diagnosis. In some embodiments, the augmentedreality device may also include an eye scanning module configured tomeasure the response of the retina to the swept light. This response maybe recorded and analyzed based on retinoscopy-specific algorithms toprovide a diagnosis to the patient. For example, algorithms can be basedat least in part on retinoscopy where a light is swept across an eye andthe reflex is observed and measured wherein refractive errors areassociated with observed or measured characteristics of the reflex. Insome implementations, the direction of the reflex movement can be usedto determine refractive errors. If, for example, the reflex moves in thesame direction as the light that is swept across the eye, ordemonstrates “with” movement, the augmented reality device can determinethat the eye of the wearer is hyperopic. Similarly, if the reflex movesin the opposite direction as the light that is swept across the eye, ordemonstrates “against” movement, the augmented reality device candetermine that the eye of the wearer is myopic. If the reflex moves in adirection that is not parallel to the direction that the light is sweptacross the eye, the augmented reality device can determine that the eyeof the wearer is astigmatic. In addition, the direction of movement ofthe reflex relative to the direction of movement of the light providedto the eye can indicate whether positive or negative refractive power isrequired to correct the vision defect. For example, “with” movementindicates positive refractive power may be required to correct therefractive error, “against” movement indicates negative refractive powermay be required, and oblique movement indicates cylindrical refractivepower may be required. As described above, different optical correction(e.g., sphere and/or cylinder with varying axes) can be provided todetermine the wearer's prescription and suitable refractive correction.

In some implementations, the speed of the reflex, combined with avirtual working distance of the augmented reality device, may also beused to determine characteristics of a visual defect. For example, thespeed of the reflex can be correlated to the ametropia or refractiveerror of the eye (e.g., faster speeds indicate lower ametropia orsmaller refractive errors of the eye).

In some implementations, the width of the reflex may also be used todetermine characteristics of a visual defect. For example, the width ofthe reflex can be correlated to the refractive error of the eye (e.g.,wider reflexes indicate lower ametropia or smaller refractive errors ofthe eye).

In some implementations, the orientation of the reflex relative to thesource light beam may also be used to determine characteristics of avisual defect. For example, a rotation of the orientation of the reflexrelative to the source light beam can be indicative of astigmatism.

In some implementations, the relative brightness of the reflex may alsobe used to determine characteristics of a visual defect. For example,the relative brightness of the reflex can be used to determine therefractive error of the eye (e.g., brighter reflexes indicate lowerametropia or smaller refractive errors of the eye).

Any combination of the above characteristics of the reflex may be usedas well to determine refractive errors. Similarly, changes in the abovecharacteristics of the reflex may be used, alone or in any combinationwith one another, to determine whether refractive corrections improve orworsen the determined refractive error, where the refractive correctionsare applied by the augmented reality device and/or resulting from theaddition or subtraction of refractive optical components or othercomponents that introduce optical correction. In some embodiments, theophthalmic system can be configured to determine in real time whetherrefractive corrections improve or worsen the determined refractiveerror. The ophthalmic system can be configured to measure or monitoraccommodation reflex by measuring accommodation, vergence, and/or pupilssize and fluctuations in these physical characteristics to assesswhether the wearer is able to see an image with normal visual acuity.For example, the accommodation, vergence, and/or pupil size of an eyefluctuate when fixated on a stationary target. These fluctuationsincrease when the eye is having trouble focusing on the image.Accordingly, the ophthalmic system can be configured to monitorfluctuations in the characteristics of the eye and uses this biofeedbackto assess the quality of the image seen by the wearer (e.g., whether thewearer is seeing an object or image with normal visual acuity).

FIG. 19 illustrates an example method 1900 for measuring refractiveerror of a wearer of an augmented reality device configured as anophthalmic device to perform retinoscopy. For ease of description, themethod 1900 will be described as being performed by an ophthalmicsystem, such as the augmented reality devices described herein. However,it is to be understood that any component or subpart of the variousaugmented reality devices disclosed herein or other similar devices canbe used to perform any step, combination of steps, or portions of a stepin the method 1900.

At block 1902, the ophthalmic system initiates a retinoscopy program.The retinoscopy program can be a stored process or sequence of functionsprovided by the ophthalmic system. Initiating the retinoscopy programcan include determining or retrieving a starting optical prescription,such as for a wearer that has previously undergone a retinoscopy test orother eye exam. In some implementations, the retinoscopy program canintegrate information about ocular anomalies of the wearer's eye(s),where the information about the ocular anomalies can be entered by thewearer or clinician, determined from a previous retinoscopy program, orretrieved from a data store (e.g., a data store that is part of theophthalmic system or a networked data store). Initiating the retinoscopyprogram can include the light beam to be projected to the wearer.Initiating the retinoscopy program can include determining whether aclinician or doctor is administering the eye exam or whether theexamination is being self-administered by the wearer. In someembodiments, the ophthalmic system initiates the retinoscopy program inresponse to input received from the wearer or a clinician.

At block 1904, a beam of light is swept through the wearer's eye. Thelight can be, for example, a beam, e.g., a spot projected into the eye.The light may be configured to be collimated, converging, diverging. Thelight can be swept across the eye or otherwise moved around the eye. Thebeam of light can be provided with optical correction to be tested,e.g., sphere and/or cylinder (with varying axes), to determine focuserror and astigmatism.

At block 1906, an eye scanning component of the ophthalmic system isconfigured to measure a response of the wearer's eye in response to theswept light, e.g., reflex from the wearer's eye. The eye scanningcomponent can be a camera or other sensor described herein. The eyescanning component can be configured to analyze the measurements of thereflex to determine refractive errors. For example, the component (e.g.,camera) can include analysis modules that are configured for a patternrecognition measurement, response pattern identification, sensormeasurement, reflex tracking, brightness measurements, speed tracking,orientation determination, or the like. The retinoscope program may beprecoded with pattern recognition algorithms to identify patterns and/orto analyze a given pattern. The retinoscope program may be precoded withprevious images from the wearer to identify changes in a historicalanalysis.

At block 1908, the wearer's eyes' response may be compared against acorrelation table that holds corresponding response values of variousvision defects. For example, at block 1908, the ophthalmic systemcompares the information measured in block 1906 with a correlation tableor other data corresponding to expected values of measurements forvarious vision defects. The comparison can be used to determinerefractive errors based on the characteristics of the reflex measured inblock 1906.

At block 1910, the values are compared in order to determine any visiondefects. Examples of characteristics and their relationship with visiondefects are described herein above. For example, the direction, speed,brightness, and/or width of the reflex can be used to determinerefractive error. The shape of the reflex can be used to determine othervision defects such as astigmatism. In some embodiments, testing can beinitiated if the wearer is struggling to focus or when problems withtheir vision occur, as represented by the dotted line from block 1910 toblock 1902.

In various embodiments, to reduce distraction the view of the world infront of the wearer's eyes through the augmented reality device isblocked or otherwise not visible during retinoscopy. This can occur, forexample, when images are presented to the wearer, although this approachis not necessary. In some embodiments, eye tracking can be employed tomonitor whether the wearer is distracted. The system can be configuredto dynamically filter out distractions based on the results ofmonitoring an eye tracking system.

Although the system has been described as an augmented reality device,in other embodiments the system may be a virtual reality device. Ineither case, the system may be a system provide by the physician orclinician for testing at a medical facility or optometrist office orelsewhere. In other embodiments, the system may belong to the wearer andmay be employed for other purposes such as entertainment (e.g., gamesand movies) and/or work activities. As described above, one benefit ofimplementing retinoscopy on the wearer's system is that the procedurecan be conveniently undertaken multiple times (at least 2, 3, 4, 5, 6,8, 10, 12, 16, 18, 24, or more times) throughout the year. In someembodiments, the frequency or schedule of the procedure can be alteredbased on results and/or trends of retinoscopy test results. For example,if the test results indicate that vision defects are deteriorating or ifthe system detects the wearer is struggling with their vision (e.g.,through analysis of accommodation fluctuations, vergence fluctuations,etc.), the frequency or schedule of the procedure can be altered toincrease the frequency of procedures and/or shorten the time betweenprocedures. Likewise, the procedure can be performed with or without amedical professional, such as optometrist, ophthalmologist, nurse,technician, medical assistant etc.

Photo-Refraction

As described herein, augmented reality devices can include an opticalscanning or optical sensing module configured to allow the device toscan an anterior and/or interior portion of the eye using known visibleand non-visible light spectrum techniques. One such technique includesphoto-refraction, which includes imaging a fundus reflex from the eye(s)of a wearer of an augmented reality device. The image of the fundusreflex can be used to determine a variety of refractive errors. Suchtechniques may be advantageous with screening non-communicative personsbecause feedback from the wearer is not required and errors can beobjectively measured.

The augmented reality device can be configured similar to the augmentedreality devices described herein. The augmented reality device caninclude a display platform configured to project an image to the eyes ofa wearer. The display platform can include one or more light sourcesthat are configured to illuminate the eyes of the wearer. The augmentedreality device can include inward-facing imaging devices (e.g., cameras)that are configured to generate images of the eyes of the wearer. Thedisplay platform can be configured to pass light from the environmentthrough the display platform to the eye of the wearer.

To act as a photo-refraction device, the augmented reality device can beconfigured to project a fixation image to the eye of the wearer (e.g.,centrally located in the wearer's field-of-view). With the eyes of thewearer fixated on the fixation image, the augmented reality device canproject a light configured to illuminate the eye of the wearer so thatthe imaging devices can capture an image of the fundus reflex from theprojected light. The image of the fundus reflex can be used to determineone or more refractive errors of the wearer. The depth plane of theprojected light can be substantially the same depth plane as thefixation image. In some embodiments, rather than providing a fixationimage, the wearer is instructed to focus on a fixation object that isplaced at a targeted distance from the wearer. In such embodiments, thedepth plane of the projected light can be substantially the samedistance as the targeted distance to the fixation object. The imagingdevice can be configured to image the eye from substantially the samedepth plane as the fixation image or object and projected light. In thisway, the eye of the wearer is substantially focused at the same depth asthe imaging device. In some embodiments, the imaging device can beconfigured to be at a conjugate plane of the retina of the wearer. Thus,in various embodiments, the effective distance from the eye to theimaging device, the effective distance from the projected light to theeye, and the effective distance from the fixation image or object to theeye can be substantially the same. In some embodiments, the effectivedistance from the eye to the fixation target, camera, and/or projectedlight is at least about 0.33 m and/or less than or equal to about 10 m,at least about 0.5 m and/or less than or equal to about 7 m, at leastabout 1 m and/or less than or equal to about 5 m, or at least about 2 mand/or less than or equal to about 3 m (e.g., about 2.4 m).

In some embodiments, the light source can provide the projected lightalong an optical axis that differs from the optical axis from the eye ofthe wearer to the imaging device. When the light source providesprojected light at an off-axis position, the image of the fundus reflexcaptured by the imaging device can be correlated to a refractive error.For emmetropic eyes, the fundus reflex will generally fill the retina.For myopic eyes, the fundus reflex forms a crescent shape with thecrescent on the same side of the retina as the off-axis projected light.For hyperopic eyes, the fundus reflex forms a crescent shape with thecrescent on the opposite side of the retina as the off-axis projectedlight. The photo-refraction device can also be configured to detectanisometropia, fragmented retinal power, lens obstructions (e.g.,cataracts, tumors, etc.), strabismus, and the like. In some embodiments,the augmented reality device is configured to compare images acquired ofthe eye of the wearer to stored images of eyes with different refractiveerrors to determine refractive errors, if any, in the eye of the wearer.In some embodiments, the augmented reality device is configured toperform pattern recognition to identify and/or determine refractiveerrors, if any, of the wearer.

The augmented reality device can be configured to determine the amountof refractive correction appropriate to correct detected refractiveerrors. For example, the characteristics of the fundus reflex can beused to determine the amount of refractive error in the eye.Accordingly, the augmented reality device can be used to automaticallydetermine a refractive correction based at least in part on themeasurements described herein. For example, there is a relationshipbetween the size of the crescent and the amount of the wearer'srefractive error. Generally, the size of the crescent is related to theeffective distance between the wearers eyes and the imaging device, thediameter of the pupils of the wearer, and the amount of the wearer'srefractive error. Thus, the augmented reality device can be configuredto determine the refractive error of the eye being measured bycontrolling or knowing the depth plane of the imaging device, bymeasuring the pupil size of the wearer, and/or by determining thecharacteristics of the fundus reflex (e.g., the size of the crescent).

In some embodiments, the sensitivity of the augmented reality device torefractive errors when operating as a photo-refractor is increased withincreased pupil size. To increase sensitivity, it may be advantageous toallow or cause the pupils of the wearer to dilate. Similarly, toincrease sensitivity, it may be advantageous to have the wearer fixateon a target at infinity. In various implementations, the target can begenerated by the augmented reality device. In some implementations, theaugmented reality device can be configured to occlude ambient light.

In some embodiments, the augmented reality device can use the describedphoto-refraction functionality to track performance or behavior of theeye of the wearer. This can be used to provide feedback to one or moretesting protocols and/or corrective protocols. The feedback can be usedto assess performance of the wearer, improvements or degradations in thevision of the wearer, track fatigue of the wearer, and the like.

For example, in various embodiments, the photo-refraction system can beused to see if refractive correction sufficiently compensates forrefractive error, to see if the natural crystalline lens is focusing theimage on the retina, and/or if the eye is correctly accommodating, e.g.,for closer objects. This system can thus monitor accommodation andwhether the wearer is struggling to accommodate or is accommodatingsuccessfully. This system can assist in evaluation an optical correctionand/or let the wear know if his/her vision is deteriorating and mightbenefit from optical correction or further testing for refractive erroror otherwise.

Slit Lamp

Various embodiments of an augmented reality/virtual reality devicedescribed herein can be configured as a slit-lamp ophthalmic diagnosticdevice. For a discussion of slit lamp instruments seehttps://en.wikipedia.org/wiki/Slit_lamp. The augmented reality/virtualreality device can comprise a head mounted display with inward facingcameras that is configured to provide images of a wearer's eye. Such adevice may, for example, comprise a frame 64, a display system 62 thatis positioned forward of the wearer's eyes, and a hardware electronicprocessing system 70, such as shown in in FIGS. 3A-3C and FIG. 5. Thisdevice may also include a light source and an outward facing camera.Such a device may be worn by the user and used to obtain images andperform diagnostic tests on the user's eyes. In particular, such anophthalmic device may comprise a bright optical source that illuminatesan aperture (e.g., a slit) and generates a thin illuminating beam. Thegenerated thin illuminating beam can be conditioned by one or morelenses and filters and directed into the eye of a user. In someembodiments, the dimensions of the aperture (e.g., length and/or widthof the slit) can be adjusted to change the dimensions of the beam oflight. Additionally, in some embodiments, the angle of incidence and/orthe brightness of the thin illuminating beam on the eye can also beadjusted in various embodiments of the slit lamp diagnostic device. Thelight reflected from the eye can be received by a receiving system(e.g., a camera, a microscope and/or a lens system) to examine variousanatomical structures of the wearer's eye including but not limited toeyelid, tear ducts, cornea, sclera, conjunctiva, iris, lens, retina,etc. onto which the thin beam of light is incident. In variousembodiments, this thin beam of light comprises a thin sheet of light atthe location the beam is incident on the eye.

Different anatomical structures of the wearer's eye or perspectivethereof can be examined by altering, the direction of the illuminatingbeam, the viewing direction, the amount of defocus of the illuminatingbeam and/or the depth of focus of the illuminating beam, (Seehttps://en.wikipedia.orq/wiki/Slit_lamp for additional information).Depending upon the observation desired and depending upon the opacity ofthe wearer's eye, methods other than direct focal examination may alsobe used. More particularly, light may be provided at various angles andof various widths ranging from narrow to wide.

FIG. 20A schematically depicts a wearable augmented realitydevice/virtual reality device 2050 that is configured as a slit-lampophthalmic diagnostic device. The device 2050 can be configured toperiodically (e.g., hourly, daily, weekly, bi-weekly, monthly,bi-annually, annually, etc.) perform a slit lamp exam of the eye. Thedevice 2050 can be configured to detect symptoms of vision impairmentsin the user's eye 2020 and perform a slit lamp exam of the eye when suchsymptoms are detected. In various embodiments, the device 2050 can beconfigured to perform a slit lamp examination of the eye at irregulartime intervals. For example, the device 2050 can be configured toperform a slit lamp examination of the eye a few times an hour, a fewtimes a week, a few times a month, a few times a year, etc. Accordingly,such test can be completed 1, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24 or moretimes a year. Such a test may be performed more often if a user has ahealth problem. The device 2050 can also be configured to be used in adoctor's office or a hospital as a slit-lamp diagnostic tool. Incontrast to a traditional table/bench top slit lamp device, theophthalmic device 2050 can be worn by a user 2060. The wearable slitlamp device 2050 can be light-weight, compact and less bulky than atraditional table/bench top slit lamp device.

The wearable device 2050 includes a frame 2064 attached to a displaysystem 2062. The display system 2062 can be configured to be positionedforward of the eyes of the wearer 2060. The display system 2062 ofvarious embodiments of the ophthalmic device 2050 can comprise a displaylens 2076 mounted in a frame 2064. In some embodiments, the display lens2076 can be a unitary lens comprising two ocular zones, each ocular zonepositioned in front of the wearer's eyes 2020. In some embodiments, thedisplay system 2062 can comprise two display lenses mounted in the frame2064, each display lens comprising an ocular zone that is positioned inthe front of each of the wearer's eyes 2062.

The wearable device 2050 can be configured to project an illuminatingbeam 2038 from an optical source 2068 into the eyes 2020 of the wearer2060. In some embodiments, the optical source 2068 can be a part of theilluminating system of the wearable augmented reality device/virtualreality device 2050 that is configured to provide illumination to thedisplay lens 2076 and/or to the eyes of the wearer. In some suchembodiments, the illuminating beam 2038 can be projected from thedisplay lens 2076 to the eye of the user. In some embodiments, theoptical source 2068 can be an auxiliary optical source disposed on aside of the display system 2062. In such embodiments, the wearableaugmented reality device/virtual reality device 2050 can include opticalcomponents, such as, for example, deflectors, reflectors, beamsplitters, diffractive optical elements lenses, etc. to direct theilluminating beam 2038 towards the wearer's eye 2020.

A portion of the projected illuminating beam 2038 can be reflected,scattered and/or diffracted by various anatomical features of the eyesof the user 2060 and received by one or more imaging devices 2074. Anelectronic hardware processor 2070 can be used to analyze light receivedfrom the eyes of the user 2060 to examine the various structures of thewearer's eye.

The illuminating beam 2038 can have a brightness that is sufficient tobe detected by the one or more imaging devices 2074. In variousembodiments, the imaging device 2074 can be inward facing. Across-sectional shape of the illuminating beam 2038 can be configuredsuch that a dimension of the cross-sectional shape along asuperior-inferior axis of the wearer's face and eye 2020 is greater thana dimension of the cross-sectional shape along a nasal-temporal axis ofthe wearer's face and eye 2020. For example, the illuminating beam canhave a rectangular cross-sectional shape having a length measured alongthe superior-inferior axis of the wearer's face and eyes 2020 greaterthan the width along the nasal-temporal axis of the wearer's face andeyes 2020. As another example, the illuminating beam can have anelliptical cross-section having a major axis oriented along thesuperior-inferior axis of the wearer's eye 2020 and the minor axisoriented along the nasal-temporal axis of the wearer's eye 2020.

The aspect ratio describing the proportionality of the height of thecross-sectional shape of the illuminating beam 2038 measured along thesuperior-inferior axis of the wearer's face and eye 2020 and the widthof the cross-sectional shape of the illuminating beam 2038 measuredalong the temporal-nasal axis of the wearer's face and eyes 2020 can be,for example, between 1.1:1 and 1.5:1; between 1.25:1 and 1.9:1; between1.51:1 and 2.6:1; between about 2:1 and 2.75:1; between about 2.49:1 andabout 3.26:1; between about 3.01:1 and about 5.2:1; between about 5.01:1and about 10:1 or aspect ratios in any of the sub-ranges of the rangesmentioned above. Accordingly, the beam of light may comprises a thinsheet at the location the beam is incident on the eye.

In various embodiments, the display system 2062 can be configuredsimilar to the display system depicted in FIG. 5 and can include one ormore features of the display system described with reference to FIG. 5.For example, the display system 2062 can comprise one or more opticalsources 2026 (e.g., infrared or visible lasers/light emitting diodes andone or more imaging devices 2024 (e.g., infrared and/or visible cameras)that are configured to track the eyes 2020 of the user 2060. In variousembodiments, the optical source 2068 can comprise the eye trackingoptical sources 2026. In various embodiments, the one or more imagingdevices 2074 can comprise the eye tracking imaging devices 2024.

As depicted in FIG. 20A, the one or more imaging devices 2074 can bedisposed around the periphery of the display system 2062 and configuredto receive light from the wearer's eyes 2020. In some embodiments, theone or more imaging devices 2074 can comprise cameras having optical andmechanical features similar to the wide-field-of-view machine visioncameras 16 that are configured to image the environment around the userand described above with reference to FIG. 5. In various embodiments,the one or more imaging devices 2074 and the optical source 2068 can beintegrated in a single device as discussed below.

As depicted in FIG. 20A, the optical source 2068 can be disposed aroundthe periphery of the display system 2062. In various embodiments, theoptical source 2068 can comprise one or more light emitting diodes thatare disposed around the periphery of the display system 2062 andconfigured to project an illuminating beam 2038 onto the wearer's eyes2020 using optical systems comprising lenses, prisms, beam splitters,mirrors and/or other optical components. In some embodiments, theoptical source 2068 can have structural and functional properties thatare similar to the projection system 18 described with reference to FIG.5.

In various embodiments, the optical source 2068 can be similar to thefiber scanning device (FSD) described above. In such embodiments, thefiber scanning device can be integrated with one or more opticalcomponents (e.g., lenses, reflective elements, light guides withdiffractive optical elements) and light from the fiber scanning devicecan be directed towards the wearer's eye 2020. In some embodiments, thedisplay lens 2076 can comprise a plurality of waveguides having opticaland structural features similar to the stacked waveguide assembly 178 ofFIG. 10D. In some such embodiments, the optical source 2068 comprising aFSD can be configured to inject light into one or more of the pluralityof waveguides such that light from the FSD propagates through the one ormore of the plurality of waveguides. Diffracting optical elements orother optical components integrated with the plurality of waveguides canbe used to direct light out of the plurality of waveguides the wearer'seye 2020.

An optical source 2068 comprising a FSD can project light in variouspatterns (e.g., raster scan, spiral scan, Lissajous patterns, etc.). Insome embodiments of the optical source 2068 can include one or moreoptical fibers similar to the FSD. In such embodiments, the one or moreoptical fibers can be configured to direct light from a light source tothe display lens 2076. The scanning fiber may be driven to scan in apattern so as to produce the beam at the eye that is a thin sheet orthat has with a cross-sectional shape longer along the superior-inferiordirection than along the nasal temporal direction or thin sheet. The oneor more optical fibers of the optical source 2068 such as comprising theFSD can be configured to receive light from the wearer's eye 2020 to theimaging device 2074. Alternatively other fibers that may or may not scanwith the fiber scanning display fiber may be used to collect thereflected light and image the eye.

The illuminating beam 2038 projected from the optical source 2068 can bedirected to be incident at a particular location of the wearer's eye2020. For example, illuminating beam 2038 can be incident at a desiredlocation of the wearer's eye 2020 such that a center of the illuminatingbeam 2038 is incident at an angle between 0 degrees and about ±90degrees with respect to a normal to the surface of the wearer's eye atthe desired location. For example, the center of the illuminating beam2038 can be scanned in an angular range that spans 180 degrees withrespect to an axis that is perpendicular (or normal) to a surface of theeye. As another example, the center of the illuminating beam 2038 can bescanned in an angular range that spans 180 degrees with respect to anaxis intersecting the eye and passing through the pupil. In variousembodiments, the center of the illuminating beam 2038 can be scannedacross the entire surface of the user's cornea, fundus and/or lens so asto image and/or examine various regions of the eye. The system 2050 canbe configured to image the eye in a variety of directions that areoriented at a variety of angles with respect to an axis intersecting theeye and passing through the pupil. The system 2050 can be configured toimage the eye along an axis intersecting the eye and passing through thepupil.

In various embodiments, the optical source 2068 can comprise a scanninglaser device that outputs an illumination beam having a spot sizebetween about 1 micron and about 1.0 mm. For example, the illuminationbeam can have a spot size between about 1-3 microns, between about 2-10microns, between about 5-25 microns, between about 10-30 microns,between about 20-100 microns, between about 50-200 microns, betweenabout 75-250 microns, between about 100-300 microns, between about225-500 microns, between about 375-600 microns, between about 500-750microns, between about 650-850 microns, between about 725 microns-1 mm,or any values in these ranges or sub-ranges. The scanning laser devicecan be configured to scan across a desired area of the eye in a desiredscan pattern. For example, the desired scan pattern can have a lengthalong the superior-inferior axis of the wearer's face that is longerthan a length along the nasal-temporal axis of the wearer's face. Thescanning laser device can be configured to scan at a speed between about1 kHz and about 5 MHz to generate the desired scan pattern. Accordingly,the desired scan pattern generated at the desired area of the eye can beconsidered to comprise a plurality of pixels that are illuminatedserially (e.g., one at a time) over the scan period. In some suchembodiments, the one or more imaging device 2074 can include aphotodetector that is configured to receive back scattered or backreflected light from each of the plurality of pixels. The intensity ofthe light received by the photodetector can be correlated to the scanangle and/or position of the illumination beam to generate atwo-dimensional image of the desired area.

The light projected from the optical source 2068 can be focused atdifferent focal distances in the wearer's eye 2020. For example, thefocus of the projected light can coincide with the cornea, the iris, thenatural lens, the vitreous or the retina. In various embodiments, one ormore adaptable optical elements or variable focusing elements (VFEs) canbe optionally used to change the angle of incidence of the lightprojected from the optical source 2068 and/or the focal plane at whichthe light projected from the optical source 2068 is focused or appearsto originate, as discussed above with reference to FIGS. 10B, 10C and10D. For example, light output from the optical source 2068 can bemodified using optical systems comprising lenses, prisms and/or mirrors(e.g., optical element 1024 of FIG. 10C) such that the depth at whichthe illuminating beam 2038 is focused in the eye and/or the direction ofthe illuminating beam 2038 on the eye 2020 of the user 2060 can bevaried.

In various embodiments, the VFEs can include deformable mirror devices.For example, the VFEs can comprise one or more electrodes coupled to amembrane mirror. A control system can be configured to selectivelycontrol the one or more electrodes to modify a shape of the membranemirror. Accordingly, the wavefront of the light emitted from the stackedwaveguide assembly can be modified by the modifying the shape of themembrane mirror. Embodiments of the wearable device 2650 that do notinclude an optical source comprising a scanning laser device or a fiberscanning device can include deformable mirror devices to steer the beamand/or to vary the depth at which the beam is focused within the user'seye. In various embodiments, the VFE's can comprise deformable lenses.In various embodiments, the VFE's can comprise deformable lenses. Thedeformable lenses can comprise an elastomeric material that can bedeformed by application of electrostatic energy to create lenses orlenticular surfaces with different curvatures. In some embodiments, theVFE's can comprise lenses that can be deformed with activation ofelectrodes. Some lenses can vary refractive index with application ofvoltage to electrodes (e.g., liquid crystal lenses). In variousembodiments, the device 2050 can comprise spatial light modulators thatmodulate the phase. Embodiments of the wearable device 2650 that includean optical source comprising a scanning laser device or a fiber scanningdevice can include deformable lenses and/or spatial light modulatorsthat modulate phase to steer the beam and/or to vary the depth at whichthe beam is focused within the user's eye.

The display lens 2076 can also comprise a plurality of stackedwaveguides configured to receive light output from the optical source2068. The plurality of stacked waveguides can have structural andfunctional properties that are similar to the stacked waveguide assembly178 illustrated in FIG. 10D and described with reference to FIG. 10D. Invarious embodiments, the plurality of stacked waveguides can comprisediffractive optical elements that are configured to in-couple lightoutput from the optical source 2068 into one or more of the stackedwaveguides. The plurality of stacked waveguides can further comprisediffractive optical elements that are configured to out-couple lightpropagating in one or more of the stacked waveguides. In variousembodiments, the diffractive optical element that are configured toin-couple and out-couple light from the optical source 2068 into or outof the plurality of stacked waveguides can be configured to modify thefocal plane and/or the direction of the illuminating beam 2038 on theeye 2020 of the wearer 2060. In various embodiments, the plurality ofstacked waveguides can include one or more lensing layers. For example,a lensing layer can be coupled with waveguides of the stacked waveguideassembly as depicted in FIG. 10D.

In various embodiments, the lensing layer can be static such that thefocal length and/or other optical properties of the lensing layer arefixed. In such embodiments, light from the optical source 2068 can becoupled in to the waveguide of the plurality of the stacked waveguideassembly that is coupled with lensing layer having optical andmechanical properties that would generate an output light beam havingthe desired direction and which would be focused or defocused at adesired position of the wearer's eye 2020.

In various embodiments, the lensing layer or other adaptive opticsincluded in the waveguide stack can be dynamic such that the focallength and/or other optical properties of the lensing layer can bevaried by application or electrical, magnetic, optical and/or mechanicalforce. In such embodiments, light from the optical source 2068 can becoupled into one or more of the waveguides of the plurality of thestacked waveguide assembly and the optical and/or mechanical propertiesof one or more lenses, lensing layers, or adaptive optical element canbe modified to generate an output light beam having the desireddirection and which would be focused at a desired position of thewearer's eye 2020. Accordingly, the focus of the slit beam on the eyecan be altered, for example, by adjusting the adaptable optics orvariable focus element.

As discussed above, the illuminating beam 2038 can have a width betweenabout 25 microns and about 1 mm. In some embodiments, the illuminatingbeam 2038 can have a width less than about 25 microns. For example, theilluminating beam 2038 can have a width between about 1-24 microns(e.g., between 1-3 microns, between 2-10 microns, between 3-15 microns,between 8-24 microns). Without subscribing to any theory, the width ofthe illuminating beam 2038 can be a maximum distance along thetemporal-nasal direction of the wearer's face and eyes 2020 of thecross-sectional shape of the illuminating at the focal plane. Forexample, the width of the illuminating beam 2038 can be between about 25microns and about 1 mm, between about 40 microns and about 950 microns,between about 60 microns and about 900 microns, between about 80 micronsand about 850 microns, between about 100 microns and about 800 microns,between about 140 microns and about 750 microns, between about 180microns and about 700 microns, between about 220 microns and about 650microns, between about 280 microns and about 600 microns, between about325 microns and about 550 microns, between about 375 microns and about500 microns, between about 400 microns and about 450 microns, or a widthhaving a value in any ranges or sub-ranges between any of these values.

In various embodiments the camera includes a lens or other imagingoptics. This lens or other imaging optics may provide a magnified viewof the eye. This lens or other imaging optics may comprise adaptableoptics or a variable focus optical element configured to be altered, forexample, to change the focus.

Accordingly, the FSD of the ophthalmic device may be used to provide anarrow (or wide beam) of light using the systems and methods discussedabove to illuminate an anterior or posterior portion of the eye. Itshould be appreciated that a focus of the light beams may be varied byone of the many way discussed in U.S. patent application Ser. No.14/555,585, incorporated by reference above. Similar to above, an eyescanning module may be used to scan the reaction (e.g., reflectionpattern, diffraction pattern, scatter pattern) of the user's eye andanalyze it to determine if there are any vision defects. In variousembodiments, a pattern matching algorithm may be used on image of theilluminated portions of the eye to determine any abnormalities.

The device 2050 comprising a fiber scanning device is adapted to form,shape and steer an optical beam. Accordingly, the device 2050 canproduce a beam 2038 with an arbitrary width, pupil location, directionand focus point and thus can be configured to reproduce thefunctionality of slit-lamp diagnostic instrument. The diffractiveoptical elements coupled to the waveguides of the stacked waveguideassembly can be configured to produce a number of different outputbeams, each with a different set of beam parameters. The various beamparameters can be further modified by additional dynamic opticalelements that can be coupled with the waveguides of the stackedwaveguide assembly. Furthermore, the waveguides of the stacked waveguideassembly can be configured to be bi-directional that can project anoptical beam as well as collect and image the light that isbackscattered from the eye.

FIG. 20B illustrates an example flowchart 2000 of a method of performinga slit lamp exam using the augmented reality/virtual reality device2050. The method of performing the slit lamp exam can be executed by theelectronic hardware processor 2070. The method of performing the slitlamp exam can be executed in accordance with a schedule or when thedevice 2050 detects that the user 2060 is having vision impairments.Referring now to FIG. 20B, at block 2002, a slit lamp program may beinitiated. At block 2004, a beam of light (i.e., generated by theoptical source 2068 such as by a FSD, a scanning laser, or other displayor auxiliary light source) of a particular focus may be projected to atleast one portion of the user's eye 2020. The portion of the user's eye2020 may be illuminated as a result. At block 2006, an image of theilluminated portion of the user's eye 2020 may be captured by theimaging system 2072. It should be appreciated that this function may beperformed, for example, by the eye tracking cameras, or a specializedcamera designed for this purpose. At block 2008, a pattern matchingalgorithm may be run against the captured image. The pattern matchingalgorithm may be executed by the electronic hardware processor 2070. Insome embodiments, the captured image from the imaging system 2072 can betransferred to the electronic hardware processor 2070 using wired orwireless technology. The pattern matching algorithm may have severalknown patterns of eye images that are indicative of various eyeabnormalities. In various embodiments, the images captured by the device2050 can be compared to images of the user's eye 2020 obtained duringprevious ophthalmoscopic exams for historical analysis. Such comparisonscan be useful to track the progression of certain diseases of the eyeover time. If the captured image matches any of those known patterns,the ophthalmic system may determine the appropriate abnormality as shownin block 2010.

In various embodiments, the electronic hardware processor 2070 can beconfigured to generate a three-dimensional map of the wearer's eye basedon the light received by one or more imaging devices 2074. For example,the obtained images can be combined and stitched using image processingmethods to create a three-dimensional topographic map of one or moreregions of the eye. Creating three-dimensional map of the eye based onthe images obtained by the device 2050 can be facilitated by differentcapabilities of the device 2050 discussed above including but notlimited to changing the position and intensity (luma) of the lightsource, changing the wavelength and/or color (chroma) of the lightsource and/or changing the position/lens/filter of the one or moreimaging devices.

Color Blindness

The ophthalmic device may also administer a color test to test apatient's deficiencies in detecting specific colors, in one or moreembodiments. For example, the device may administer the Ishihara colortest, which is designed to test for red-green color perceptiondeficiencies. The test includes showing a series of colored plates(“Ishihara plates”), similar to the one shown in FIG. 21A, to thewearer. As shown in FIG. 21A, the color plate contains a circle of dotswhich appear to be randomized in size and randomized or uniform incolor. Within each circle are patterns of dots which form a number orshape. In some circles, the number or shape is clearly visible only forviewers with normal color vision, but difficult or impossible to see forviewers who have a red-green perception deficiency. In other circles,the number or shape is only visible for viewers with a red-green defect.In some embodiments, color plates may be selected and/or modified basedon known conditions and/or previous responses of the wearer. Colors orother stimuli may be changed incrementally to determine the bounds of awearer's color perception deficiency. That is, hues may change from afirst color to a second color through a plurality of hues. For example,a wearer with a detected red-green deficiency may be presented withplates gradually changing the red color to orange or purple, and thewearer's response to each incremental change may be recorded.

In one or more embodiments, the ophthalmic device may be programmed in amanner similar to the above process flows to administer the Ishiharacolor test by providing virtual images of each of the color plates, andreceiving user input regarding the color plate. Referring to FIG. 5,virtual images of the color plates may be provided by a display 106 orother light-emitting module 27. The color plates may be projected in anaugmented reality display device 62, with light from the world formingthe background surrounding the color plate. In some embodiments, thedevice may provide a background in addition to the color plate, so as toenhance the visibility of the color plate. For example, the backgroundmay be a solid color or a dark background. A dark backgroundapproximating black is not projected, but is the result of a lack ofillumination. Thus, a dark background may be generated by using one morespatial light modulators (SLMs), e.g., a stack of two or more SLMs, thatcan be used to attenuate light rays, such that the region surroundingthe color plate appears black, nearly black, grey, or otherwise darkenedto the wearer. Various SLMs may be used, such as liquid crystal displaypanels, MEMS shutter displays, DLP DMD arrays, or the like. One way toselectively attenuate for a darkfield perception is to block all of thelight coming from one angle, while allowing light from other angles tobe transmitted. In some embodiments, multiple SLMs may be used to blockmore angles of light.

For example, FIG. 21B depicts an embodiment including two SLMs 2180 and2182, which may be liquid crystal display panels, MEMS shutter displays,DLP DMD arrays, or the like, which may be independently controlled toblock or transmit different rays. For example, if the second panel 2182blocks or attenuates transmission of rays at point “a” 2184, all of thedepicted rays will be blocked. But if only the first panel 2180 blocksor attenuates transmission of rays at point “b” 2186, then only thelower incoming ray 2188 will be block or attenuated, while the rest willbe transmitted toward the pupil 2145. Additional numbers of SLMs beyondtwo provides more opportunities to more precisely control which beamsare selectively attenuated. Thus, a relatively dark background may beprovided against which to display color plates, as described above.

The ophthalmic system may automatically determine whether the user has ared-green vision defect or other defects based on the input receivedfrom the wearer in response to the color test. The user input regardingthe color plate may be produced and/or received by any suitable methodfor a user to input a description of a number, letter, shape, or otherimage characteristic. For example, the input may be received through auser interface such as a keyboard, number pad, or touch screen havingkeys or virtual buttons corresponding to the numbers utilized in theIshihara plates. In some embodiments, the system may be configured toreceive a spoken input from the wearer, and to determine the wearer'sresponse to the test using voice recognition. A user interface mayfurther have an option for the wearer to indicate that no number orshape was observed.

In some embodiments, the wearer may provide input through the ophthalmicdevice, for example, by selecting a virtual button projected by a FSD orother display element of the ophthalmic device. Instead or in addition,the ophthalmic device may be further configured to determine if thewearer saw the number or shape in the projected Ishihara plate withoutconscious input from the wearer. For example, the system may detect afixation of the gaze of the wearer on the location of the number orshape in the Ishihara plate for a sufficiently long period of time to bean indication that the number or shape was seen, while an extendedperiod of scanning of the image by the wearer may indicate an inabilityto see the number or shape. For example, the system may track thewearer's gaze for a period of up to one second, five seconds, tenseconds, or longer.

In various embodiments, the system may use patterns and/or images otherthan Ishihara plates that test a wearer's ability to detect differentcolors. For example, the ophthalmic device may be configured to functionas an RGB anomaloscope. A test based on color matching of two imagesand/or light sources is used to provide color detection testing. Onesource or image can have a fixed control color, while the other sourceor image is adjustable by the viewer (e.g., a fixed-spectral image thatcan be adjusted in brightness). The viewer may be presented with avariety of control colors, and attempts to match the adjustable image tothe control image, or determine that a match cannot be made.

The ophthalmic device may perform this function by projecting multiplecolored light beams or images onto the retina. As discussed above, thelight source may be the FSD (or DLP, etc.) or a separate light source 27configured for this very purpose. For example, multiple FSDs may be usedto project light, each FSD projecting light of a different color asneeded by the RGB anomaloscope. Alternatively, a light source thatproduces multiple colors may be used. The images may be projected usingthe display, for example, through one or more waveguides as describedelsewhere herein.

In some embodiments, a traditional split image may be displayed. Inother embodiments, a full-field image may be displayed. In otherembodiments, an opaque back screen may be added digitally ormechanically, for example, using electronics and/or a shutter and/or amovable baffle. As discussed above, this may be administered by aclinician or doctor, or may simply be used by the user, in otherembodiments. The ophthalmic system may determine one or more visiondefects by receiving input regarding each image (e.g., whether there isa match or a lack of match). As described above with reference toIshihara color testing, user input may be provided via a user interfacesuch as a keyboard, touch pad, voice recognition or other input device,and/or may be provided through a virtual user interface projected withinthe ophthalmic device. Based on the received input, the ophthalmicsystem may provide a diagnosis or evaluation of the RGB anomaloscopetest.

In various embodiments, the ophthalmic system may be configured toadminister color testing repeatedly and/or periodically. For example,the system may test a wearer's color perception periodically, such asseveral times per day or one or more times per week, month, or year, andcompare the results over time. The ophthalmic system may, for example,test more than once a year, twice a year, three times a year, four timesa year, six times a year, 8 times a year, 10 times a year, 12 times ayear, 16 times a year, 18 times a year, or more. Additionally, theophthalmic system may, for example, test more than once a week, twice aweek, three times a week, four times a week, six times a week, 8 times aweek, 10 times a week, 12 times a week, 14 times a week, 18 times ayear, or more. Additionally, the ophthalmic system may, for example,test more than once a day, twice a week, three times a week, four timesa week, five times a day, six times a week or more. In some embodiments,the frequency of regularly scheduled tests may be automatically adjustedbased on trending color blindness testing results and/or based on adetection that the wearer is having difficulty distinguishing colors. Insuch cases, the system may be able to better detect the severity ortime-variation of a wearer's color detection deficiency by testing thewearer's color vision at various times of day and in various lightconditions. Similarly the system may be able to obtain more completeand/or accurate results by testing a wearer's color vision repeatedly atdifferent depth planes, degrees of accommodation, and/or areas of theretina. Accordingly, the system may be able to vary the depth plane,accommodation, and/or area of the retina when administering a colorvision test. Repeated testing over longer time periods, such as monthsor years, may allow for the tracking of any improvement or degenerationof a wearer's color detection deficiency, such as due to maculardegeneration or any other progressive conditions.

The ophthalmic system may be configured for therapeutic functions suchas compensating for color detection deficiencies of the wearer. In someembodiments, the system may be configured for both detection (asdescribed above) and therapeutic functions. Therapeutic functions mayinclude modifying color, intensity, and/or other qualities of imagesand/or light from the world entering the eye of the user. For example,the system may function as a color enhancer by increasing the intensityof light in a portion of an image containing a color of reduceddetection. In some embodiments, the system may shift the color of such aregion, such as by changing the wavelength of the light or adding lightof a different wavelength, so as to present light of a color that thewearer is better able to detect. Color shifting may be accomplishedthrough a multi-notch optical filter capable of notch filtering out thespectral overlap between different photopigments. For example, in somecases of color blindness, the absorptance spectra of the red and greencones may overlap more than normal, causing difficulty in distinguishingred and green. A multi-notch filter may be used to filter out some ofthe wavelengths of light between red and green (e.g., those wavelengthswith relatively high absorptance for both red and green cones) so thatthe wavelengths that reach the eye are more easily discernable as red orgreen. In embodiments comprising an augmented reality device, the systemmay similarly modify the wearer's view of light from the world. Theaugmented reality system may detect the colors of light entering thedevice in real time or near real time, and may modify portions of thelight or project additional light to correct for the wearer's colordetection deficiency. For example, the system may use outward-facingcameras to image the world and color sensors determine the colors ofobjects. The system may project additional light of same or differentcolor to augment the intensity in areas of reduced detection ability soas to at least partially mitigate the color detection deficiency of thewearer. The system may further incorporate a labeling function, whereinthe name of a known deficient color may be augmented over a region ofthe outside light determined to be of that color. In some embodiments,superposition may be used to enhance color in a portion of the displayby projecting light of a desired amplitude, such as by adding a tint tothe image.

A similar method may be used in a virtual reality system. The virtualreality system may have a forward and outward looking camera that imagesthe world in front of the wearer and determines the colors of objects.The virtual reality system may reproduce to the wearer an image of theworld based on the output of the outward-facing cameras, with somemodifications of color and/or brightness and/or other parameters asdescribed above. For example, the virtual reality system may increasethe intensity of the image in areas of reduced detection ability so asto at least partially mitigate the color detection deficiency of thewearer.

Ophthalmoscope/Funduscope

Various embodiments of an augmented reality/virtual reality device thatcan be worn by a user 2260 as described herein can be configured tofunction as an ophthalmoscope/funduscope. FIG. 22A schematically depictsan wearable device 2250 that is configured as anophthalmoscope/funduscope. The device 2250 includes a frame 2264attached to a display system 2262. The display system 2262 can beconfigured to be positioned forward of the eyes 2220 of the user 2260.The device 2250 can be configured to project a beam of light 2238 froman optical source 2268 into the eyes 2220 of the user 2260. A portion ofthe projected beam 2238 can be reflected, scattered and/or diffracted byvarious anatomical features of the eyes 2220 of the user 2260 andreceived by one or more imaging devices 2274. An electronic hardwareprocessor 2270 can be used to analyze light received from the eyes 2220of the user 2260 to examine the various structures of the user's eye2220.

In various embodiments of the ophthalmic system 2250, the frame 2264 canbe structurally and/or functionally similar to the frame 64 of FIGS.3A-3C. In various embodiments of the ophthalmic system 2250, the displaysystem 2262 can be structurally and/or functionally similar to thedisplay system 62 of FIGS. 3A-3C and FIG. 5. In various embodiments ofthe ophthalmic system 2250, the electronic hardware processor 2270 canbe similar to the local processing and data module 70 of FIGS. 3A-3C.

The wearable device 2250 configured as an ophthalmoscope can be used toexamine various parts of the user's eye 2220 including but not limitedto the fundus of the eye 2220. The fundus comprises the retina, opticdisc, macula, fovea and posterior pole of the eye, and other structures.The wearable device 2250 can be configured such that a clinician canview various features of the user's eye and detect any abnormalities byviewing the output of the one or more imaging devices 2274. For example,the eye's fundus is one of the parts of the human body wheremicrocirculation can be observed. Accordingly, an examination of thefundus by the wearable device 2250 may advantageously be used to notonly detect eye-related health conditions, but other health conditionsof the body as well (e.g., brain abnormalities, heart abnormalities,etc.).

The display system 2262 of various embodiments of the device 2250 cancomprise a display lens 2276 mounted in the frame 2264. In someembodiments, the display lens 2276 can be a unitary lens comprising twoocular zones, each ocular zone positioned in front of the user's eyes2220. In some embodiments, the display system 2262 can comprise twodisplay lenses mounted in the frame 2264, each display lens comprisingan ocular zone that is positioned in the front of each of the user'seyes 2220.

In some embodiments, the optical source 2268 can be a part of theilluminating system of the wearable device 2250 that is configured toprovide illumination to the display lens 2276 and/or to the eyes of theuser. In some such embodiments, the beam 2238 can be projected from thedisplay lens 2276 into the eye 2220 of the user 2260. For example, theoptical source 2268 can comprise a fiber scanning device (FSD) and thedisplay lens can comprise a plurality of waveguides. Light from the FSDcan be injected into one or more of the plurality of waveguides andemitted from the one or more of the plurality of waveguides into the eye2220 of the user to perform ophthalmoscopic/funduscopic functions.

In some embodiments, the optical source 2268 can be an auxiliary opticalsource disposed on a side of the display system 2262. In suchembodiments, the wearable system 2250 can include optical components,such as, for example, lenses or other refractive components, reflectivesurfaces, deflectors, reflectors, beam splitters, diffractive opticalelements, waveguides, or other optical components, etc. to direct thebeam 2038 towards the wearer's eye 2220. For example, in certainembodiments, the ophthalmic system 2250 can comprise an additional FSDand the display lens can comprise additional waveguides (e.g., anadditional stack of waveguides). Light from the additional FSD can beinjected into one or more additional waveguides and emitted from the oneor more waveguides into the eye 2220 of the user to performophthalmoscopic/funduscopic functions.

In various embodiments, the optical source 2268 can comprise a scanninglaser device that outputs an illumination beam having a spot sizebetween about 1 micron and about 1.0 mm. For example, the illuminationbeam can have a spot size between about 1-3 microns, between about 2-10microns, between about 5-25 microns, between about 10-30 microns,between about 20-100 microns, between about 50-200 microns, betweenabout 75-250 microns, between about 100-300 microns, between about225-500 microns, between about 375-600 microns, between about 500-750microns, between about 650-850 microns, between about 725 microns-1 mm,or any values in these ranges or sub-ranges. The scanning laser devicecan be configured to scan across a desired area of the eye in a desiredscan pattern. The scanning laser device can be configured to scan at aspeed between about 1 kHz and about 5 MHz to generate the desired scanpattern. Accordingly, the desired scan pattern generated at the desiredarea of the eye can be considered to comprise a plurality of pixels thatare illuminated serially (e.g., one at a time) over the scan period. Insome such embodiments, the one or more imaging device 2274 can include aphotodetector that is configured to receive back scattered or backreflected light from each of the plurality of pixels. The intensity ofthe light received by the photodetector can be correlated to the scanangle and/or position of the illumination beam to generate atwo-dimensional image of the desired area.

In various embodiments the wearable ophthalmic system 2250 can comprisea concave mirror with a hole in the center through which light receivedfrom the eye 2220 can be directed towards the one or more imagingdevices 2274. In such embodiments, the beam of light 2238 can bereflected into the eye of the user by the concave mirror. In variousembodiments, a lens can be rotated into the opening in the mirror toneutralize the refracting power of the eye, thereby making the image ofthe fundus clearer. Accordingly, in some embodiments, the wearableophthalmic system 2250 can comprise one or more optical components thatare configured to direct the beam of light 2238 from the optical source2268 into the eye of the user and direct light received from the eye2220 of the user 2260 towards the one or more imaging devices 2274. Theoptical components can comprise reflective optical elements, beamsplitters, diffractive optical elements, refractive optical elements,light guides with redirecting elements, etc.

As discussed above, the system 2250 configured for non-healthapplications (e.g., for entertainment such as watching movies or videos,playing games, for work, etc.) can also be used to providefunduscope-like applications. The system 2250 can be configured toperiodically (e.g., hourly, daily, weekly, bi-weekly, monthly,bi-annually, annually, etc.) perform an ophthalmoscopic/funduscopicexamination. In various embodiments, the system 2250 can be configuredto perform an ophthalmoscopic/funduscopic examination of the eye 2220 atirregular time intervals. For example, the system 2250 can be configuredto perform an ophthalmoscopic/funduscopic examination a few times anhour, a few times a week, a few times a month, a few times a year, etc.Accordingly, such a test can be completed 1, 2, 3, 4, 5, 6, 8, 10, 12,16, 24 or more times a year. Such a test may be performed more often ifa user has a health problem or when the system 2250 detects symptoms ofvisual impairments (e.g., the system 2250 detects that the user 2260 ishaving difficulty in focusing at objects). The system 2250 can also beconfigured to be used in a doctor's office or a hospital as anophthalmoscopic/funduscopic examination. In contrast to a traditionaltable/bench top ophthalmoscope/funduscope, the ophthalmic system 2250can be worn by a user 2060. The wearable ophthalmoscope/funduscopedevice 2050 can be lightweight, compact and less bulky than atraditional table/bench top ophthalmoscope/funduscope device.

The projection beam 2238 can have a brightness that is sufficient to bedetected by the one or more imaging devices 2274. In variousembodiments, the projection beam 2238 can be configured to illuminate acircular portion of the eye having a diameter between about 1 micron andabout 25 mm. For example, the circular portion of the eye illuminated bythe projection beam 2238 can have a diameter that is substantially equalto (e.g., within about ±10% (or smaller) of) the diameter of the retinameasured from the fovea of an average eye. As another example, thecircular portion of the eye illuminated by the projection beam 2238 canhave a diameter that is between about 1 micron and about 25 microns,between about 25 microns and about 100 microns, about 50 microns andabout 250 microns, about 100 microns and about 500 microns, about 200microns and about 750 microns, about 350 microns and about 800 microns,about 500 microns and about 1.0 mm, about 600 microns and about 1.5 mm,about 1.0 mm and about 2.0 mm, about 2.7 mm and about 25 mm; betweenabout 3.0 mm and about 22 mm; between about 3.5 mm and about 20 mm;between about 4.0 mm and about 18 mm; between about 4.5 mm and about 15mm; between about 5.0 mm and about 12.5 mm; between about 5.5 mm andabout 11.0 mm: between about 7.5 mm and about 10 mm; or a value in anyof these ranges or sub-ranges. In various embodiments, the projectionbeam 2238 can be configured to illuminate an area of the eye having adimension between about 1 micron and about 25 mm. For example, thedimension of the area illuminated by the projection beam can be greaterthan or equal to about 1 micron and less than or equal to about 3microns, greater than or equal to about 2 microns and less than or equalto about 5 microns, greater than or equal to about 5 microns and lessthan or equal to about 10 microns, greater than or equal to about 10microns and less than or equal to about 15 microns, greater than orequal to about 12 microns and less than or equal to about 25 microns,greater than about 25 microns and less than or equal to about 25 mm,greater than about 50 microns and less than or equal to about 20 mm,greater than about 100 microns and less than or equal to about 15 mm,greater than about 250 microns and less than or equal to about 10 mm,greater than about 500 microns and less than or equal to about 5 mm,greater than about 1.0 mm and less than or equal to about 2.5 mm, or avalue in any of these ranges or sub-ranges.

In various embodiments, the projection beam 2238 can be directed (e.g.,focused) towards a desired location. A scanning fiber device, scanninglaser device and/or adaptive optics may be used to direct the beam tothe particular location. For example, the projection beam 2238 can bedirected at the cornea; directed at the iris; directed at the lens;directed at the vitreous or directed at the retina to examine otherparts of the eyes in addition to the fundus. In order to examinedifferent parts of the eye, the projection beam 2238 can be focused atvarying depths in the eye that can be achieved by varying the scan angleof the scanning fiber device, varying the focal length of the adaptiveoptical elements that are used to focus the projection beam 2238 and/orby varying the zoom of the one or more imaging devices 2274.

Various embodiments of the device 2250 illustrated in FIG. 22A can beconfigured to capture images from various depths in the eye of the user2260. In some such embodiments of the device 2250, the one or moreimaging devices 2274 can include an imaging camera configured to capturelight emitted from different depths in the user's eye 2260. For example,the focal length of the lens of the imaging camera can be varied tocapture light emitted from different depths in the user's eye 2260. Someembodiments of the device 2250 configured to capture light emitted fromdifferent depths in the user's eye 2260 can include a plurality ofimaging cameras that are focused at structures in the user's eye 2260that are located at different depths in the user's eye 2260. Lightemitted from a particular depth in the user's eye 2260 can be capturedby the imaging cameras that are focused to view structures in the user'seye 2260 at that particular depth. Embodiments of the device 2250comprising a plurality of imaging cameras that are focused at structuresin the user's eye 2260 can be used to collect light emitted fromdifferent depths in the user's eyes 2220 simultaneously.

A scanning optical source (e.g., a fiber scanning device) that isconfigured to inject light into a stacked waveguide assembly including aplurality of lens systems (e.g., lenses or diffracting optical elementshaving an overall negative optical power) and output coupling elementsthat are configured to emit light from the waveguide such that theemitted light appears to originate for a different depth plane can beused to collect light from different depths in the user's eyes 2220simultaneously. FIG. 22C is a schematic partial illustration of anembodiment comprising a stacked waveguide assembly that comprises aplurality of waveguides (e.g., 22005 a, 22005 and 22005 c) and a firstplurality of scanning fiber devices (e.g., 22003 a and 22003 b)configured to inject light from one or more optical sources into one ofthe plurality of waveguides. A lensing layer 22007 can be coupled witheach of the plurality of waveguides. The lensing layer 22007 can includelens elements that provide a net negative optical power such that theuser perceives light emitted from the different waveguides to originatefrom a different depth layer. A lensing layer 22009 can be coupled witheach of the plurality of waveguides to image the light output fromdifferent depths in the eye. The lensing layer 22009 coupled withwaveguides that are configured to image cornea, iris or the lens cancomprise lens elements that provide a net positive optical power. Thelensing layer 22009 coupled with waveguides that are configured to imagethe retina may include lens elements that provide a net negative opticalpower to compensate for the optical power provided by the cornea and thelens.

In some embodiments, the lensing layers 22007 and 22009 can comprisestatic lens elements with fixed focal length and/or optical power. Insome embodiments, the lensing layers 22007 and 22009 can comprisedynamic lens elements with variable focal length and/or optical power.For example, the lensing layers 22007 and 22009 can comprise variablefocusing elements and/or adaptive optics having variable focal lengthand/or optical power as described herein.

In accordance with the principle of reciprocity of light, light emittedfrom different depths in the user's eye 2220 can be collected by variouswaveguides of the stacked waveguide assembly and coupled into a secondplurality of scanning fiber devices (e.g., 22010 a and 22010 b). Each ofthe second plurality of scanning fiber devices (e.g., 22010 a and 22010b) is associated with a waveguide of the stacked waveguide assembly andconfigured to direct the received light towards a detector. In variousembodiments, the first plurality of scanning fiber devices can beconfigured to emit light into the associated waveguide as well ascollect light from the associated waveguide. Accordingly, the need forthe second plurality of scanning fiber devices can be eliminated in suchembodiments. Furthermore, in embodiments wherein the first plurality ofscanning fiber devices are configured to emit light as well as collectlight, a fiber coupler/splitter can be coupled with each of the firstplurality of scanning fiber devices to separate the optical path fromthe optical source and the optical path towards the detector. Thelensing layers (e.g., 22009 a and 22009 b) comprising lens elements withpositive optical power can be configured to compensate the effect of thelens elements with negative optical power on the received light. Invarious embodiments, the lens elements with positive optical power canbe disposed at the output of the waveguides instead of being integratedwith the stacked waveguide assembly as shown in FIG. 22C

The first and/or the second plurality of fiber scanning devices can eachcomprise single core fibers or multicore fibers. The implementation ofthe system discussed above can also be configured to simultaneously emitmultiple wavelengths of light and/or receive multiple wavelengths oflight. The implementation of the system discussed above can beintegrated with other ophthalmic devices described herein including butnot limited to eyewear configured as a slit-lamp diagnostic tool,eyewear configured as a confocal microscope, eyewear configured as ascanning laser opthalmoscope, eyewear configured as a two-photonmicroscope, eyewear configured as an OCT system, etc.

In various embodiments, the optical source 2268 can be configured togenerate a white light. Accordingly, in such embodiments, the projectionbeam 2238 can comprise a white light. In some embodiments, the opticalsource 2268 can be configured to generate a colored light comprising arange of wavelengths of the visible spectral region. For example, theoptical source 2268 can generate a light of any color having wavelengthsin the range between about 440 nm and about 510 nm; between about 460 nmand about 550 nm; between about 490 nm and about 560 nm; between about530 nm and about 610 nm; between about 550 nm and about 620 nm; or avalue in any of these ranges or sub-ranges.

In some embodiments, the optical source 2268 can be configured togenerate an infrared light comprising one or more wavelengths in a rangeof wavelengths in the infrared spectrum of light. For example, theprojection beam 2238 can comprise one or more wavelengths in the nearinfrared spectrum of light; in the mid infrared spectrum of light and/orin the far infrared spectrum of light. As another example, theprojection beam 2238 can comprise one or more wavelengths between about700 nm and about 1.5 μm; between about 1.0 μm and about 2.3 μm; betweenabout 1.8 μm and about 3.2 μm; between about 2.4 μm and about 5.8 μm;between about 3.2 μm and about 7.0 μm; and/or between about 6.0 μm andabout 13.0 μm. The penetration depth of the projection beam 2238 in theeye 2220 of the wearer 2260 can depend on the wavelengths included inthe projection beam 2238. Accordingly, varying the wavelengths includedin the projection beam 2238 advantageously can allow imaging ofstructure and anatomical features at different depths in the eye 2220 ofthe user 2260.

Embodiments of the system 2250 including an optical source 2268configured to generate visible/infrared light can be configured for usein fluorescence ophthalmology. For example, fluorescent dye can beapplied to the user's eyes 2220 and the fluorescence resulting afterilluminating the fluorescent dye with radiation from the optical source2268 can be analyzed to obtain information about the health of theuser's eyes 2220. In various embodiments, the fluorescent dye can bedelivered by a fluid delivery system integrated with the system 2250.For example, the fluorescent dye can be delivered by a dispensing modulesimilar to the medication dispensing module (21) described withreference to and illustrated in FIG. 5. The system 2250 configured foruse in fluorescence ophthalmology can be useful to detect and/ordiagnose various ophthalmic diseases and conditions. For example, acorneal ulcer stained with a fluorescent dye appears green when viewedunder cobalt-blue light. Accordingly, comeal ulcers can be detected whena fluorescent dye (e.g., fluorescein) is applied to the cornea andilluminated by beam 2238 having wavelength similar to wavelength ofcobalt-blue light.

Various embodiments of the one or more imaging devices 2274 can includeone or more wavelength filters configured such that the imaging devices2274 can selectively receive light at one or more desired wavelengthranges from the eye 2220 of the wearer 2260 while attenuating orfiltering out other wavelengths. For example, the imaging devices 2274can include one or more wavelength filters configured such that theimaging devices 2274 can selectively receive light in visible spectralrange, near infrared spectral range, mid infrared spectral range and/orfar infrared spectral ranges. As another example, the imaging devices2274 can include one or more wavelength filters configured such that theimaging devices 2274 can selective receive light between about 440 nmand about 12.0 μm; between about 500 nm and about 10.0 μm; between about550 nm and about 8.5 μm; between about 600 nm and about 5.0 μm; betweenabout 650 nm and about 3.0 μm; between about 1.0 μm and about 2.5 μm orany values in the above-identified ranges and sub-ranges whileattenuating or filtering out wavelengths outside of the selected range.

As depicted in FIG. 22A, the one or more imaging devices 2274 can bedisposed around the periphery of the display system 2262 and configuredto receive light from the user's eyes 2220. In various embodiments, theone or more imaging devices 2274 can comprise cameras similar to theinfrared cameras 2224 that are configured to track the user's eyes 2220and described above with reference to FIG. 5. In some embodiments, theone or more imaging devices 2274 can comprise cameras similar to thewide-field-of-view machine vision cameras 16 that are configured toimage the environment around the user and described above with referenceto FIG. 5. In various embodiments, the one or more imaging devices 2274and the optical source 2268 can be integrated in a single device asdiscussed below.

As depicted in FIG. 22A, the optical source 2268 can be disposed aroundthe periphery of the display system 2262. In various embodiments, theoptical source 2268 can comprise one or more light emitting diodes thatare disposed around the periphery of the display system 2262 andconfigured to project the beam 2238 into the user's eyes 2220. Someembodiments may use one or more optical systems comprising lenses,prisms, beam splitters, mirrors, light guides (with or withoutdiffractive optical elements), diffractive optical components, prismaticcomponents and/or other optical components to direct the beam 2238 intothe user's eyes 2220. In some embodiments, the optical source 2268 canhave similar characteristics as the projection system 18 described withreference to FIG. 5.

As discussed above, in various embodiments, the optical source 2268 canbe similar to the fiber scanning device (FSD) described above. In suchembodiments the optical source 2268 can include one or more opticalfibers similar configured to transmit light from a light emitter (e.g.,laser/LED) towards the eyes 2220 of the user 2260. In such embodiments,the fiber scanning device can be integrated with one or more opticalcomponents (e.g., reflective elements, refractive elements, diffractiveoptical elements, light guides with diffractive optical elements and/orother optical components) and light from the fiber scanning device canbe directed towards the user's eye 2020. In some embodiments, thedisplay lens 2276 can comprise a plurality of waveguides having opticaland structural features similar to the stacked waveguide assembly 178 ofFIG. 10D. In such embodiments, the optical source 2268 comprising a FSDcan be configured to inject light into one or more of the plurality ofwaveguides such that light from the FSD propagates through the one ormore of the plurality of waveguides. Diffracting optical elements orother optical components integrated with the plurality of waveguides canbe used to direct light out of the plurality of waveguides the user'seye 2020.

An optical source 2268 configured as a FSD can scan in a variety ofpattern (e.g., raster scan, spiral scan, Lissajous patterns, etc.) andspeeds. The projected light pattern of the beam 2238 can depend on thescan pattern of the FSD, the scanning speed of the FSD and/or the speedof the one or more imaging devices 2274. In some embodiments of theoptical source 2268 configured similar to the FSD, the optical fibersthat are configured to transmit light from the optical source may alsobe used to receive light from the user's eye 2220.

The projection beam 2238 projected from the optical source 2268 can bedirected to be incident at a particular location of the wearer's eye2220. For example, projection beam 2238 can be incident at a desiredlocation of the wearer's eye 2220 such that a center of the projectionbeam 2238 is incident at an angle between 0 degrees and about ±90degrees with respect to a normal to the surface of the wearer's eye atthe desired location. For example, the center of the projection beam2238 can be scanned in an angular range that spans 180 degrees withrespect to an axis that is perpendicular (or normal) to a surface of theeye. As another example, the center of the projection beam 2238 can bescanned in an angular range that spans 180 degrees with respect to anaxis intersecting the eye and passing through the pupil. The projectionbeam 2238 can be configured to illuminate the entire back hemisphere ofthe user's eye 2220. As another example, the projection beam 2238 fromthe optical source 2268 can be incident at a desired location of theuser's eye 2220 at an angle with respect to the user's line of sight.The light projected from the optical source 2268 can be focused atdifferent focal distances in the user's eye 2220. For example, the focalplane of the projected light can coincide with the cornea, the iris, thenatural lens, the vitreous, the fovea or the retina.

In various embodiments, adaptive optics or variable focusing elements(VFEs) can be optionally used to change the angle of incidence of thelight projected from the optical source 2268 and/or the focal plane atwhich the light projected from the optical source 2268 is focused, asdiscussed above with reference to FIGS. 10B, 10C and 10D. For example,light output from the optical source 2268 can be modified using opticalsystems comprising lenses, prisms and/or mirrors (e.g., optical element1024 of FIG. 10C) such that the depth at which the beam of light 2238 isfocused in the user's eye 2220 and/or the direction of the beam 2238 onthe eye 2220 of the user 2260 can be selected. Adaptive optics can beused to control/shape the wavefront of the beam of light 2238, controlthe direction of the beam of light 2238, convergence or divergence ofthe beam of light 2238, and/or remove optical aberrations from the lightreceived from the eye.

In various embodiments, the VFEs can include deformable mirror devices.For example, the VFEs can comprise one or more electrodes coupled to amembrane mirror. A control system can be configured to selectivelycontrol the one or more electrodes to modify a shape of the membranemirror. Accordingly, the wavefront of the light emitted from the stackedwaveguide assembly can be modified by the modifying the shape of themembrane mirror. Embodiments of the wearable device 2650 that do notinclude an optical source comprising a scanning laser device or a fiberscanning device can include deformable mirror devices to steer the beamand/or to vary the depth at which the beam is focused within the user'seye. In various embodiments, the VFE's can comprise deformable lenses.The deformable lenses can comprise an elastomeric material that can bedeformed by application of electrostatic energy to create lenses orlenticular surfaces with different curvatures. In some embodiments, theVFE's can comprise lenses that can be deformed with activation ofelectrodes. Some lenses can vary refractive index with application ofvoltage to electrodes (e.g., liquid crystal lenses). In variousembodiments, the device 2250 can comprise spatial light modulators thatmodulate the phase. Embodiments of the wearable device 2650 that includean optical source comprising a scanning laser device or a fiber scanningdevice can include deformable lenses and/or spatial light modulatorsthat modulate phase to steer the beam and/or to vary the depth at whichthe beam is focused within the user's eye.

The display lens 2276 can comprise or be integrated with a plurality ofstacked waveguides configured to receive light output from the opticalsource 2268. The plurality of stacked waveguides can havecharacteristics that are similar to the stacked waveguide assembly 178illustrated in FIG. 10D and described with reference to FIG. 10D. Invarious embodiments, the plurality of stacked waveguides can comprisediffractive optical elements that are configured to in-couple lightoutput from the optical source 2268 into one or more of the stackedwaveguides. The plurality of stacked waveguides can further comprisediffractive optical elements that are configured to out-couple lightpropagating in one or more of the stacked waveguides. In variousembodiments, the diffractive optical elements that are configured toin-couple and out-couple light from the optical source 2268 into or outof the plurality of stacked waveguides can be configured to modify thefocal plane and/or the direction of the illuminating beam 2238 on theeye 2220 of the user 2260. In various embodiments, the plurality ofstacked waveguides can include one or more lensing layers. For example,a lensing layer can be coupled with each waveguide of the stackedwaveguide assembly as depicted in FIG. 10D. In various embodiments, thelight source used to provide illumination for theophthlamoscope/funduscope may comprise such waveguide configurations. Insome embodiments, this waveguide assembly and/or the fiber scanningdisplay or other light source coupling light into the waveguide assemblymay comprise the same components that are used to project images intothe eye for the augmented reality or virtual reality. In someembodiments, this waveguide assembly and/or the fiber scanning displayor other light source coupling light into the waveguide assembly may beintegrated with similar components that are used to project images intothe eye for the augmented reality or virtual reality. For example,additional waveguides may be added to the waveguide assembly to provideillumination to the eye and or to collect light from the eye to providethe ophthalmoscope/funduscope imaging. Similarly, additional lightsources such as FSD may be added to inject light into waveguides of thewaveguide assembly to provide illumination to the eye and or to collectlight from the eye to provide the ophthalmoscope/funduscope imaging.

In various embodiments, the lensing layer can be static such that thefocal length and/or other optical properties of the lensing layer arefixed. In such embodiments, light from the optical source 2268 can becoupled in to the waveguide of the plurality of the stacked waveguideassembly that is coupled with lensing layer having characteristics thatwould generate an output light beam having the desired direction andwhich would be focused at a desired location of the user's eye 2220.

In various embodiments, the lensing layer can be dynamic such that thefocal length and/or other optical properties of the lensing layer can bevaried by application of an electrical signal. In such embodiments,light from the optical source 2268 can be coupled into one or more ofthe waveguides of the plurality of the stacked waveguide assembly andthe characteristics of one or more lensing layers can be modified togenerate an output light beam having the desired direction and whichwould be incident at a desired position of the user's eye 2220.

The system 2250 comprising a fiber scanning device and/or a scanningdevice discussed above is adapted to form, shape and steer an opticalbeam. Accordingly, the system 2250 can produce a beam 2238 with anarbitrary width, pupil location, direction and focus point and thus canbe configured to reproduce the functionality of an ophthalmoscope orfunduscope. The diffractive optical elements coupled to the waveguidesof the stacked waveguide assembly can be configured to produce a numberof different output beams, each with a different set of beam parameters.The various beam parameters can be modified by additional dynamicoptical elements that can be coupled with the waveguides of the stackedwaveguide assembly. Furthermore, the waveguides of the stacked waveguideassembly can be configured to be bi-directional that can project anoptical beam as well as collect and image the light that isbackscattered from the eye.

Accordingly, the FSD of the ophthalmic device (or other light source)may be configured to project a light beam to the anterior or posteriorportion of the eye and capture an image of the user's eye using thesystems and methods discussed above. It should be appreciated that afocus of the light beams may be varied by one of the many way discussedin U.S. patent application Ser. No. 14/555,585, incorporated byreference above. Similar to above, an eye scanning module may be used toscan the light from the eye (e.g., reflection pattern, diffractionpattern, scatter pattern) of the user's eye and analyze it to determineif there are any vision defects. As in the case of other embodimentsdescribed above and elsewhere herein, the ophthalmic system may receiveinput from the user, or analyze the captured image and run it throughvarious pattern matching algorithms to determine any abnormalities. Invarious embodiments, the images captured by the system 2250 can becompared to images of the user's eye 2220 obtained during previousophthalmoscopic exams for historical analysis. Such comparisons can beuseful to track the progression of certain diseases of the eye overtime.

FIG. 22B illustrates an example flowchart 2200 of a method of examiningthe eye (e.g., fundus or retina) using the ophthalmic system 2250. Themethod of examining the eye can be executed by the electronic hardwareprocessor 2270 in conjunction with the optical system 2250. The system2250 can be configured to initiate an ophthalmoscopic/funduscopicexamination of the eye if it detects that the user 2260 is havingdifficulty in focusing or has some other visual impairments. Referringnow to FIG. 22B, at block 2202, a funduscope program may be initiated.At block 2204, a beam of light of a particular focus may be projected toat least one portion of the user's eye using the optical source 2268. Asdiscussed above, the optical source 2268 can include the fiber scanningdevice or an alternate optical source, such as, for example, infraredsources configured to track the user's eye. The portion of the user'seye may be illuminated as a result. At block 2206, the system maycapture an image of the illuminated portion of the user's eye. It shouldbe appreciated that this function may be performed by the eye trackingcameras, FSD, or a specialized camera designed for this purpose asdiscussed above. At block 2208, a pattern matching algorithm can be usedto compare the captured image with several known images that areindicative of various eye abnormalities. In various embodiments, theimages obtained/captured by the system 2250 can be processed using acolor matching algorithm wherein the color of one or more portions ofthe obtained/captured images can be compared with the color of those oneor more portions with previously obtained/captured images or some storedimages. The several known images may be stored in a library that isaccessible by the electronic hardware processor 2270. For example, theimages obtained/captured by the system 2250 can be stored in anelectronic medical record (EMR) associated with the user 2260 forhistorical analysis.

The images obtained/captured by the system 2250 can be analyzed usingimage processing algorithms, such as, for example, pattern matchingalgorithm, color matching, etc. determine any abnormalities. Forexample, the images can be analyzed to determine if the optic disc isswollen or appears to have blurred edges/margins. As another example,the images can be analyzed to measure a size of the optic disc and/oroptic cup. The measured sizes of the optic disc and/or cup can be usedto obtain a cup-to-disc ratio which is calculated as a ratio between thediameter of the cup portion of the optic disc and the total diameter ofthe optic disc. A higher value of the cup to disc ratio can beindicative of glaucoma. As yet another example, the images can beanalyzed to determine the color of the fundus. A darker colored fundusmay be indicative of retinitis pigmentosa. In contrast, a pale coloredfundus may be seen in users with arterial occlusion. The images obtainedby the ophthalmoscope may be analyzed to detect other abnormalities suchas, for example, hemorrhages or exudates. A green filter (thatattenuates red light substantially) may advantageously make it easier todetect hemorrhages or exudates. Users with hypertensive retinopathy canexhibit hard exudates, hemorrhages (rarely papilloedema) and/or retinaloedema which can be detected from the images obtained by the system2250. Some users with diabetic retinopathy can exhibit dot and blothemorrhages and/or hard exudates which can be detected from the imagesobtained by the system 2250. Some users with diabetic retinopathy canalso exhibit cotton wool spots or soft exudates.

As described above, in addition to looking for common eye defects, themicro capillaries of the eye may be indicative of other health issues aswell. The conditions of the retina or retinal vessels can be indicativeof certain vascular diseases or other diseases. For example, the bloodvessels in each of the four quadrants of obtained images can be examinedto determine the conditions of arteries are usually thinner and crossveins, determine the number of vessels, determine whether the vesselsare straight or tortuous, determine the color and width of the vessels,determine the light reflex and points of crossing. These determinationsmay provide an indication of the user's health. For example, arteriolarchanges, arteriolar vasoconstriction/narrowing, changes in arteriolarwall (arteriosclerosis), etc. can be indicative of hypertensiveretinopathy. As another example, manifestations of copper wirearterioles and silver wire arterioles, and “arterio-venular (AV)nicking/nipping”, due to venous constriction and banking can also beindicative of hypertensive retinopathy. New vessel formation aroundoptic disc and/or microaneurysms may be indicative of diabeticretinopathy.

As discussed above, in various embodiments, pattern matching algorithmmay be configured to compare the captured image with a library of knownpatterns that are indicative of different types of diseases and/orabnormalities that may affect the health of the eye. If the capturedimage includes patterns that match any of the known patterns, theophthalmic system 2250 may be configured to determine the correspondingabnormality or disease progression as shown in block 2210. The resultsof the pattern matching algorithm and/or the captured image maysubsequently be displayed to the clinician and/or the user, in one ormore embodiments.

Confocal Microscopy/Two-Photon Microscopy/SLO

Various embodiments of an augmented reality/virtual reality system thatcan be worn by a user as described herein can be configured to performconfocal microscopy. FIG. 24C schematically depicts a wearable device2650 that can be configured to perform confocal microscopy. The device2650 includes a frame 2664 attached to a display system 2662. Thedisplay system 2662 can be configured to be positioned forward of theeyes 2620 of the user 2660. The device 2650 can be configured to projecta beam of light 2638 from a light source 2668 into the eyes 2620 of theuser 2660. A portion of the projected beam 2638 can be reflected,scattered and/or diffracted by various anatomical features of the eyes2620 of the user 2660 and received by one or more imaging devices 2674.An electronic hardware processor 2670 can be used to analyze lightreceived from the eyes 2620 of the user 2660 to examine the variousstructures of the users eye 2620.

In various embodiments of the ophthalmic system 2650, the frame 2664 canhave characteristics similar to the frame 64 of FIGS. 3A-3C. In variousembodiments of the ophthalmic system 2650, the display system 2662 canhave characteristics similar to the display system 62 of FIGS. 3A-3C andFIG. 5. In various embodiments of the ophthalmic system 2650, theelectronic hardware processor 2670 can be similar to the localprocessing and data module 70 of FIGS. 3A-3C.

The display system 2662 of various embodiments of the ophthalmic system2650 can comprise a display lens 2676 mounted in the frame 2664 throughwhich the wearer can view the world. In some embodiments, the displaylens 2676 can be a unitary lens comprising two ocular zones, each ocularzone positioned in front of the user's eyes 2620. In some embodiments,the display system 2662 can comprise two display lenses mounted in theframe 2664, each display lens comprising an ocular zone that ispositioned in the front of each of the user's eyes 2620.

The optical source 2668 can comprise a light emitter including one ormore lasers, one or more LEDs, one or more flashlamps and/or one or moresuperluminescent diodes. In some embodiments, the optical source 2668can be a part of the illuminating system of the wearable device 2650that is configured to provide illumination to the display lens 2676and/or to the eyes 2620 of the user 2660. In some such embodiments, thebeam 2638 can be projected from the display lens 2676 into the eye 2620of the user 2660. For example, the optical source 2668 can comprise afiber scanning device (FSD) and the display lens can comprise aplurality of waveguides having characteristics similar to the waveguidestack 178 described above with reference to FIG. 10D. Light from the FSDcan be injected into one or more of the plurality of waveguides andemitted from the one or more of the plurality of waveguides into the eye2620 of the user to perform confocal microscopy. The plurality ofwaveguides of the display lens can be coupled with adaptive focusingelements that can change characteristics of the wavefront emitted fromthe plurality of waveguides.

In some embodiments, the optical source 2668 can be an auxiliary opticalsource disposed on a side of the display system 2662. In suchembodiments, the wearable system 2650 can include optical components,such as, for example, lenses or other refractive components, reflectivesurfaces, deflectors, reflectors, beam splitters, diffractive opticalelements, waveguides, or other optical components, etc. to direct thebeam 2638 towards the wearer's eye 2620. For example, the optical source2668 can comprise an additional FSD and the display lens can comprise anadditional stack of waveguides. Light from the additional FSD can beinjected into one or more waveguides of the additional stack ofwaveguides and emitted from the one or more waveguides of the additionalstack of waveguides into the eye 2620 of the user to perform confocalmicroscopy. The waveguides in the additional stack of waveguides can becoupled with adaptive focusing elements that can change characteristicsof the wavefront emitted from the additional stack of waveguides.

When the device 2650 is configured as a confocal microscope, lightoutput from the optical source 2638 can be directed towards a desiredregion of the eye 2620 (such as the retina) through a first aperture andfocused on the part of the eye through a first lens. In variousembodiments, the first lens images the first aperture onto the eye andin particular the region of the eye to be imaged. The first aperture andthis region of the eye to be imaged are at conjugate focal planes (ofthe first lens). Light scattered/reflected/diffracted from the part ofthe eye is directed through a second lens towards the one or moreimaging devices 2674 through a second aperture. The second aperture andthe region of the eye to be imaged are at conjugate focal planes (of thesecond lens). The second aperture can have a dimension such thatout-of-focus light from the desired region of the eye is rejected by thesecond aperture and not incident on the one or more imaging devices2674.

In various embodiments, a single lens is used as the first lens and thesecond lens. The single lens may be disposed between the eye and thebeamsplitter and the beamsplitter may be in an optical path between thefirst aperture and the lens and as well as in an optical path betweenthe second aperture and the lens. As described above, the first apertureand the region of the eye to be measured are at conjugate focal planesof the lens. Similarly, the second aperture and the region of the eye tobe measured are at conjugate focal planes of the lens.

In various embodiments, the first and the second apertures can coincidesuch that the device 2650 includes only a single aperture disposed inthe confocal plane of the lens configured to direct focused light ontothe desired region of the eye 2620 and receive light from desired regionof the eye 2620 while rejecting out-of-focus light.

Various embodiments of the device 2650 comprising a fiber scanningdevice configured as the optical source 2668 and/or configured toreceive light from the desired region of the eye 2620 and direct towardsthe one or more imaging devices 2674 need not include a separate firstand/or second aperture. Instead, in some such embodiments, the outputaperture of the optical fibers that are included in the fiber scanningdevice can be configured as the first and/or the second aperture. Thefirst and/or the second aperture can comprise a pinhole. Variousembodiments of the device 2650 in which a same fiber of the fiberscanning device is configured to project the illuminating light beam aswell as to receive light from the desired region of the eye 2620 anddirect towards the one or more imaging devices 2674 as illustrated inFIG. 24D-1 is configured as a confocal microscope by its nature.

As discussed above, various embodiments of the device 2650 configured asan confocal microscope can include a beam splitter and/or a fibersplitter/coupler that is disposed in the optical path to direct lightfrom the optical source 2668 towards the desired region of the user'seye 2620. The beam splitter can be further configured to direct lightoriginating from the desired region of the user's eye 2620 towards theone or more imaging devices 2674. Various embodiments of the device 2650can comprise one or more scanning mirrors (e.g., horizontal and verticalscanning mirrors), deformable mirror devices, etc. such that lightoutput from the optical source 2668 can be scanned across a region(e.g., retina, cornea, lens, vitreous humor) of the user's eye 2620confocal microscopy can be performed by the device 2650. The horizontaland vertical scanning mirrors can scan in the lateral directions (x andy) in comparison to the longitudinal direction (z) which can correspondto the optical axis of the system and which may be orthogonal to thelateral directions (x and y). FIG. 24D-2 is a schematic partialillustration of an embodiment of an eyewear comprising an optical source2668, one or more imaging device 2674, a beam splitter, a lensing systemand a scanning mirror. The scanning mirror illustrated in FIG. 24D-2 cancomprise a deformable mirror device in some embodiments.

In one or more embodiments of the device 2650 comprising a fiberscanning device (FSD) as the optical source 2668, the FSD can serve as a3D scanning head configured to scan light across the region of theuser's eye 2620. In one or more embodiments light beams of varyingwavelengths (i.e., other than visible light spectrum) may be projected(e.g., through FSD or other optical sources) to provide additional 3Dresolution.

FIG. 24D-1 schematically depicts a partial view of an embodiment of thedevice 2650 comprising a fiber scanning device that is configured tooutput the projection beam 2638 as well as receive light from thedesired region of the eye 2620 and direct the received light towards theone or more imaging devices 2674. In the illustrated embodiments, theFSD is configured to inject light into one or more waveguides of astacked waveguide assembly. Light propagating through the waveguide canbe out-coupled from the waveguide by diffractive optical elementscoupled to the waveguide. The stacked waveguide assembly can furthercomprise optional variable focusing elements (VFEs) and/or optionaladaptable optical elements that are configured to change the wavefrontof the light out-coupled from the waveguide. In some embodiments, thestacked waveguide assembly can further comprise a plurality ofdeformable mirror devices that can scan the projection beam 2638 inhorizontal and vertical directions across the region of the user's eye2620.

The light projected from the optical source 2668 can be focused atdifferent focal distances in the wearer's eye 2620. For example, thefocus of the projected light 2638 can coincide with the cornea, theiris, the natural lens, the vitreous or the retina. In variousembodiments, one or more adaptable optical elements or variable focusingelements (VFEs) can be optionally used to change the angle of incidenceof the light projected from the optical source 2668 and/or the focalplane at which the light projected from the optical source 2668 isfocused or appears to originate, as discussed above with reference toFIGS. 10B, 10C and 10D. For example, light output from the opticalsource 2668 can be modified using optical systems comprising lenses,prisms and/or mirrors (e.g., optical element 1024 of FIG. 10C) such thatthe depth in the eye at which the projected beam 2638 is focused and/orthe direction of the illuminating beam 2638 on the eye 2620 of the user2660 can be varied.

In various embodiments, the VFEs can include deformable mirror devices.For example, the VFEs can comprise one or more electrodes coupled to amembrane mirror. A control system can be configured to selectivelycontrol the one or more electrodes to modify a shape of the membranemirror. Accordingly, the wavefront of the light emitted from the stackedwaveguide assembly can be modified by the modifying the shape of themembrane mirror. Embodiments of the wearable device 2650 that do notinclude an optical source comprising a scanning laser device or a fiberscanning device can include deformable mirror devices to steer the beamand/or to vary the depth at which the beam is focused within the user'seye. In various embodiments, the VFE's can comprise deformable lenses.The deformable lenses can comprise an elastomeric material that can bedeformed by application of electrostatic energy to create lenses orlenticular surfaces with different curvatures. In some embodiments, theVFE's can comprise lenses that can be deformed with activation ofelectrodes. Some lenses can vary refractive index with application ofvoltage to electrodes (e.g., liquid crystal lenses). In variousembodiments, the device 2650 can comprise spatial light modulators thatmodulate the phase. Embodiments of the wearable device 2650 that includean optical source comprising a scanning laser device or a fiber scanningdevice can include deformable lenses and/or spatial light modulatorsthat modulate phase to steer the beam and/or to vary the depth at whichthe beam is focused within the user's eye.

In various embodiments, the optical source 2668 can comprise a scanninglaser device that outputs an illumination beam having a spot sizebetween about 1 micron and about 1.0 mm. For example, the illuminationbeam can have a spot size between about 1-3 microns, between about 2-10microns, between about 5-25 microns, between about 10-30 microns,between about 20-100 microns, between about 50-200 microns, betweenabout 75-250 microns, between about 100-300 microns, between about225-500 microns, between about 375-600 microns, between about 500-750microns, between about 650-850 microns, between about 725 microns-1 mm,or any values in these ranges or sub-ranges. The scanning laser devicecan be configured to scan across a desired area of the eye in a desiredscan pattern. The scanning laser device can be configured to scan at aspeed between about 1 kHz and about 5 MHz to generate the desired scanpattern. Accordingly, the desired scan pattern generated at the desiredarea of the eye can be considered to comprise a plurality of pixels thatare illuminated serially (e.g., one at a time) over the scan period. Insome such embodiments, the one or more imaging devices 2274 can includea photodetector that is configured to receive back scattered or backreflected light from each of the plurality of pixels. The intensity ofthe light received by the photodetector can be correlated to the scanangle and/or position of the illumination beam to generate atwo-dimensional image of the desired area. In various embodiments, aplurality of photodetectors can be disposed about a periphery of theeyewear that are configured to collect the backscattered radiation. Insuch embodiments, the two-dimensional image of the desired area can begenerated by averaging the intensity detected by the plurality ofdetectors over time.

In various embodiments, the optical source 2668 can be configured togenerate a white light or a colored light comprising a range ofwavelengths of the visible spectral region. For example, the opticalsource 2668 can generate a light of any color having wavelengths in therange between about 440 nm and about 510 nm; between about 460 nm andabout 550 nm; between about 490 nm and about 560 nm; between about 530nm and about 610 nm; between about 550 nm and about 620 nm; or a valuein any of these ranges or sub-ranges.

In some embodiments, the optical source 2668 can be configured togenerate infrared light comprising one or more wavelengths in a range ofwavelengths in the infrared spectrum of light. For example, theprojection beam 2668 can comprise one or more wavelengths in the nearinfrared spectrum of light; in the mid infrared spectrum of light and/orin the far infrared spectrum of light. As another example, theprojection beam 2668 can comprise one or more wavelengths between about700 nm and about 1.5 μm; between about 1.0 μm and about 2.3 μm; betweenabout 1.8 μm and about 3.2 μm; between about 2.4 μm and about 5.8 μm;between about 3.2 μm and about 7.0 μm; and/or between about 6.0 μm andabout 13.0 μm.

The penetration depth of the projection beam 2668 in the eye 2620 of thewearer 2660 can depend on the wavelengths included in the projectionbeam 2638. Additionally, the optical path length difference between theprojection beam 2638 and the reference beam can also depend on thewavelength. Accordingly, varying the wavelengths included in theprojection beam 2638 advantageously can allow imaging of structure andanatomical features at different depths in the eye 2620 of the user2660.

As depicted in FIG. 24C, the one or more imaging devices 2674 can bedisposed around the periphery of the display system 2662 and configuredto receive light from the user's eyes 2620. In various embodiments, theone or more imaging devices 2674 can comprise inward facing cameras. Forexample, the one or more imaging devices 2674 can comprise camerashaving characteristics similar to the infrared cameras 2624 that areconfigured to track the user's eyes 2620 and described above withreference to FIG. 5. In some embodiments, the one or more imagingdevices 2674 can comprise cameras similar to the wide-field-of-viewmachine vision cameras 16 that are configured to image the environmentaround the user and described above with reference to FIG. 5. The one ormore imaging devices 2674 can comprise photodiodes (e.g., silicon-based,Germanium-based for IR light, photomultiplier tubes (PMTs),charge-coupled devices (CCDs), CMOS based sensors, Shack-Hartmanwavefront sensors etc.). As discussed above, in various embodiments, theone or more imaging devices 2674 can be integrated with the FSDconfigured as an optical source 2668. For example, the optical fibers ofthe FSD can be configured to receive light received from the eye anddirect the received light to the one or more imaging devices 2674.

Various embodiments of the one or more imaging devices 2674 can includeone or more wavelength filters configured such that the imaging devices2674 can selectively receive light at one or more desired wavelengthranges from the eye 2620 of the wearer 2660 while attenuating orfiltering out other wavelengths. For example, the imaging devices 2674can include one or more wavelength filters configured such that theimaging devices 2674 can selectively receive light in visible spectralrange, near infrared spectral range, mid infrared spectral range and/orfar infrared spectral ranges. As another example, the imaging devices2674 can include one or more wavelength filters configured such that theimaging devices 2674 can selective receive light between about 440 nmand about 12.0 mm; between about 500 nm and about 10.0 mm; between about550 nm and about 8.5 mm; between about 600 nm and about 5.0 mm; betweenabout 650 nm and about 3.0 mm; between about 1.0 mm and about 2.5 mm orany values in the above-identified ranges and sub-ranges whileattenuating or filtering out wavelengths outside of the selected range.

The information and/or images captured by the one or more imagingdevices 2674 may be processed in real-time or later. In variousembodiments, the system 2650 can include optical sources and detectorsthat track the movement of the eye. The optical sources and detectorsthat track the movement of the eye can have characteristics similar tothe source 26 and cameras 24 described with reference to FIG. 5. The eyetracking optical sources and detectors may be used to cancel out anyeffects of eye movement and/or to reduce noise.

As discussed above, the wearable device 2650 may be configured to notonly project light associated with visible light (usually done throughRGB sources), but may also be configured with other multi-spectralcomponents (e.g., laser sources, infrared sources, LED light etc.) toemit light having a range of wavelengths and spectral compositions. Or,in other embodiments, tunable lasers may be used (e.g., cavity lengthmay change in the laser or diffractive gratings may be modified) thatare capable of changing the wavelength of light over time, on aframe-sequential basis, line-sequential basis, pixel by pixel basis,etc.

Multi-spectral light emission may be advantageous for imaging purposesbecause different parts of the eye may react better to other colors orspectra of light, leading to more accurate imaging techniques. Thus, thewearable device 2650 configured as a confocal microscope may compriseadditional components that are configured to emit multi-spectral light.

FIG. 24E illustrates an example flowchart 2600 of a method of examiningthe eye using the ophthalmic system 2650. The method of examining theeye can be executed by the electronic hardware processor 2670 inconjunction with the optical system 2650. Referring now to FIG. 24E, anexample process flow 2600 is provided. At block 2602, a confocalmicroscopy program may be initiated. At block 2604, one or more beams oflight may be directed to a desired region of the user's eyes through afirst aperture using the optical source 2654. At block 2606 one or moreimages of the desired region can be obtained by one or more imagingdevices 2674 through a second aperture. At block 2608 the obtainedimages of the desired region can be analyzed to detect abnormalities ofthe eye 2620. For example, the obtained images can be compared withstored images accessible by the electronic hardware processor 2670 usingpattern matching algorithms to detect abnormalities. The stored imagescan comprise images of healthy eyes, images that show characteristics ofeye affected with particular diseases and/or images of the user's eyesobtained from past examinations. The electronic hardware processor 2670can be configured to obtain quantitative measurements (e.g., volumetricmeasurements) of various parts of the obtained images of the user's eye.The quantitative measurements can be transmitted to a clinician forfurther analysis. As another example, one or more parameters can beextracted from the obtained images to detect abnormalities. The obtainedimages and/or the quantitative measurements can be used to monitor eyehealth or disease progression.

Various embodiments of the device 2650 can be configured to performscanning laser ophthalmoscopy (SLO) which comprises a confocalmicroscope for diagnostic imaging of the retina or cornea. Embodimentsof the device 2650 configured as a scanning laser ophthalmoscopecomprise a laser as the light emitter of the optical source 2668. Lightfrom the laser can be focused at a desired region of the eye (e.g.,retina). The laser light can be scanned across the desired region andreflected light can be captured through a small aperture (e.g. apinhole) such that out-of-focus light can be suppressed or eliminated.One or more scanning mirrors can be used to move the laser light acrossthe desired region. In some embodiments, the laser light can begenerated by a FSD that can be configured to scan in a variety ofpatterns (e.g., raster scan, spiral scan, Lissajous patterns, etc.) andspeeds. The projected light pattern across the desired regions candepend on the scan pattern of the FSD, the scanning speed of the FSDand/or the speed of the one or more imaging devices. In this manner, SLOcan be used to obtain a sharp, high contrast image of the desiredregion. The image obtained by SLO can have a high degree of spatialsensitivity.

Various embodiments of the device 2650 can be configured to performadaptive optics scanning laser ophthalmoscopy (AOSLO) that uses adaptiveoptics to remove optical aberrations of the eye such as of the corneaand lens. In various embodiments, for example, the device 2650 mayoptionally include one or more adaptive optical elements or VFEsdisposed in the optical path from the laser light source 2654 to the eyeand from the imaging devices 2674 to the eye. The adaptive opticalelement or VFE may comprise, for example, such as a deformable mirrorand may be configured as described herein. Additionally, an aberrometersuch as a Shack-Hartman wavefront sensor, can be disposed to receivelight returned from the eye such as describe herein. The aberrometer isconfigured to measure the aberrations wavefront of the eye as discussedabove. Processing electronics can be configured to drive the adaptiveoptics, e.g., the deformable mirror, so as to alter the wavefrontsdirected to and from the eye so as to compensate for or reduce theeffect of the aberration of the eye on the wavefront. As a result ofreduced aberrations introduced by the eye, AOSLO can provide a greaterdegree of accuracy when compared to SLO.

The systems and methods described above to perform confocal microscopy,scanning laser ophthalmoscopy or adaptive optics scanning laserophthalmoscopy can also be used to perform multi-photon microscopy ortwo-photon microscopy (or multi-photon fluorescence or two-photonfluorescence microscopy). For example, a fluorescent dye can be providedto a desired or target region of user's eye. In some embodiments, thefluorescent dye is ejected from a port on the wearable device 2650 andapplied to the eye as described herein. The wearable device 2650 can beconfigured such that one or more drops of fluorescent dyes can beapplied or sprayed onto the eye. Fluorescence can be produced in thetarget region by absorption of two-photons. Two-photon absorptioninvolves the absorption of light of lower energy by a medium and theresultant emission of higher energy light. In certain cases, two-photonsof the lower energy light are absorbed and one photon of the higherenergy is emitted. The amount of light required to excite fluorescenceby the two-photon absorption process can be high. Accordingly, the lightemitter of the optical source 2668 in the wearable device 2650 that isconfigured to perform two-photon microscopy may comprise a high radiancesource. The radiance of the light emitter included in a systemconfigured to perform two-photon microscopy can be of the order of10¹⁰-10¹² W/cm² in some embodiments. The light emitter can include acontinuous-wave (CW) laser having sufficient power that can provide theradiance levels for performing two-photon microscopy. In someembodiments, the light emitter can include a pulsed laser, such as, forexample, a femto-second laser or a pico-second laser. The pulsed lasercan be configured to operate at high repetition rates to achieve higherpeak power that may assist in increasing two-photon excitationefficiency. In some other embodiments, the light emitter can comprise amode-locked laser or a fiber laser that is configured to outputultra-fast pulses (e.g., pico-second pulses or femto-second pulses). Thelight emitted from the laser can have wavelengths between about 700-1600nm.

In various embodiments of the optical source included in eyewearconfigured to perform scanning laser ophthalmoscopy, adaptive opticsscanning laser ophthalmoscopy and/or multi-photon microscopy cancomprise a laser. Light from the laser can be coupled into the fiberscanning device (FSD), which in certain embodiments injects the lightinto one or more waveguides of the stacked waveguide assembly. Lightpropagating through the one or more waveguides can be out-coupled bydiffractive optical elements or other optical elements in variousembodiments. Light output from the waveguides can be shaped by one ormore variable focusing elements comprising adaptive optics and directedtowards a target region of the user's eye. The FSD, however, need not beused in conjunction with a waveguide stack. In various embodiments, theFSD can be configured to scan in a variety of patterns (e.g., rasterscan, spiral scan, Lissajous patterns, etc.) and speeds. The projectedlight pattern to the target region can depend on the scan pattern of theFSD, the scanning speed of the FSD and/or the speed of the one or moreimaging devices. In some embodiments, deformable mirror devices can beemployed to steer light output from the waveguides to the target regionof the user's eye. The deformable devices can be employed in addition toor instead of scanning the FSD in a variety of directions.

In various embodiments, the optical source included in eyewearconfigured to perform scanning laser ophthalmoscopy, adaptive opticsscanning laser ophthalmoscopy and/or multi-photon microscopy cancomprise a scanning laser device that outputs an illumination beamhaving a spot size between about 1 micron and about 1.0 mm. For example,the illumination beam can have a spot size between about 1-3 microns,between about 2-10 microns, between about 5-25 microns, between about10-30 microns, between about 20-100 microns, between about 50-200microns, between about 75-250 microns, between about 100-300 microns,between about 225-500 microns, between about 375-600 microns, betweenabout 500-750 microns, between about 650-850 microns, between about 725microns-1 mm, or any values in these ranges or sub-ranges. The scanninglaser device can be configured to scan across a desired area of the eyein a desired scan pattern. For example, the desired scan pattern canhave a length along the superior-inferior axis of the wearer's face thatis longer than a length along the nasal-temporal axis of the wearer'sface. The scanning laser device can be configured to scan at a speedbetween about 1 kHz and about 5 MHz to generate the desired scanpattern. Accordingly, the desired scan pattern generated at the desiredarea of the eye can be considered to comprise a plurality of pixels thatare illuminated serially (e.g., one at a time) over the scan period. Insome such embodiments, the one or more imaging device 2074 can include aphotodetector that is configured to receive back scattered or backreflected light from each of the plurality of pixels. The intensity ofthe light received by the photodetector can be correlated to the scanangle and/or position of the illumination beam to generate atwo-dimensional image of the desired area.

In some embodiments, the light output from the waveguide can be focusedat the target region of the user's eye 2620 by the variable focusingelements. Two-photon excitation can be achieved in the focal volume ofthe target region in which the optical energy is sufficiently high. Forexample, in various embodiments, two-photon excitation can be excited ina diffraction-limited focal volume of the target region of the user'seye 2620. In various embodiments, the light output from the laser can befocused to a spot size that corresponds to the diffraction-limited spot.Light emitted from the volume of the target region in which two-photonexcitation is achieved can be directed towards the one or more imagingdevices 2674. As described above, the light output from the waveguidescan be scanned horizontally and/or vertically in the target region ofthe user's eye to construct two-dimensional images of the target region.Additionally, by varying the depth in the eye at which light output fromthe waveguide is focused, three-dimensional images can be constructed.In various embodiments, the depth in the eye at which light output fromthe waveguide is focused can be varied based on the scan angle of thefiber scanning device. In some embodiments, the depth in the eye atwhich the beam 2638 is focused can be varied by varying the wavelengthof light. In some other embodiments, the depth in the eye at which thebeam 2638 is focused can be varied by scanning the beam along alongitudinal axis of the beam 2638 that is aligned with the direction ofpropagation of the beam 2638. In various embodiments, the longitudinalaxis of the beam 2638 can be aligned with the line of sight of the user2620.

Since the light received by the one or more imaging devices when thedevice 2650 is configured as a two-photon microscope is confined to thefocal volume, out-of-focus light or any other stray light can berejected by providing appropriate filters configured for the wavelengthof the two-photon emission. Such filters may comprise transmissionfilters that are configured to substantially transmit light havingwavelength corresponding to the emission of the two-photon excitationprocess while reducing transmission of other wavelengths. Other types offilters or filter configurations the can separate out the wavelengthcorresponding to the emission of the two-photon excitation process fromother wavelengths can be used.

Accordingly, various embodiments the augmented or virtual realityeyewear may comprise a multi-photon microscope or two-photon microscope.

The device 2650 configured as a confocal microscope, a scanning laserophthalmoscope, adaptive optics scanning laser ophthalmoscope and/ortwo-photon microscope can be used to visualize retinal topography, deepfundus imaging (i.e., detecting lesions), retinal pigment epithelium(RPE) changes and other age related macular degeneration. The device2650 configured as a confocal microscope, a scanning laserophthalmoscope, adaptive optics scanning laser ophthalmoscope and/ortwo-photon microscope may also be used to provide a multi-spectral imagecomparison, which can help improve visual discrimination of retinal andsub-retinal features through spectral and depth enhanced differentialvisibility.

In various embodiments, the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can allow a clinicianto view the obtained images of the user's eye in real time. For example,the system can be configured to allow the clinician to read a word thatthe user is seeing and/or view the scene that the user is seeing. Thedevice 2650 can be configured to allow a clinician to determine in realtime which part of the retina the user is using to see. For example,most users normally rely on the foveal region of the retina to see.However, users with macular degeneration may rely on other parts of theretina to see. Various embodiments of augmented reality/virtual realityeyewear described herein, such as, for example, the device 2650configured as a confocal microscope, a scanning laser ophthalmoscope,adaptive optics scanning laser ophthalmoscope and/or two-photonmicroscope can be configured to perform micro visual fields testing. Adevice configured to perform micro visual fields testing comprisesplacing small targets on the retina that can be viewed by the user anddetermining the blind spots of the retina based on the user's feedbackand/or ability to see the small targets.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured tomeasure refractive error. For example, a size of the image on the backof the retina can be measured by the clinician to determine if it issmaller, larger, out of focus or has some other deficiencies.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured totrack eye movement of the user 2660 which can be advantageous inproviding the ability to view the objects and scenes that the user 2660is viewing in real-time.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured tomeasure the thickness of the retina, thickness of the macula and/orthickness of individual retinal layers.

For example, scanning laser ophthalmoscopy or confocal scanning laserophthalmoscopy (cSLO) can be used to scan across the retina inaccordance with a scan pattern (e.g., a raster scan). Light from thescanned region of the retina can be received at the one or more imagingdevices 2674 to construct a two/three-dimensional image of the retina.For example, sequential cSLO scans captured at increasing depths can becombined to create three-dimensional topographic images of the retina oroptic disc. Image stacks can be aligned to create a final compositeimage to provide retinal thickness, measurements of the macula and otherparameters of the retina. In one or more embodiments, an aperture can bepositioned in front of the one or more imaging device 2674 to rejectout-of-focus light that may add noise or aberrations to the constructedtwo/three-dimensional image of the retina.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured toimage the macula of the user 2660. The macula images can be useful tomeasure thickness of the macula as discussed above. The macula imagescan also be useful to determine swelling of the macula. This can beadvantageous in early detection of glaucoma—which causes structuralchanges in the macula before functional changes. For example, glaucomacan cause loss of retinal ganglion cells, changes in the inner plexiformlayer, thinning of certain retinal layers, etc. These structural changescan be determined from the images of the retina and/or macula.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured toimage the shape of the front and the back surface and/or thickness ofthe lens of the user 2660 so as to determine accommodation state basedon the shape of the lens and/or measure refractive error. For example,the user 2660 can be made to focus on targets at different depths byprojecting the beam 2638 from different depth planes. The changes in theaccommodation state of the lens as well as the size and acuity of theimages formed on the retina can be imaged to assist in determiningrefractive errors.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured todetermine spatial distribution and anisotropy of cone cells aroundfovea. This can be advantageous in determining if the user is myopic,emmetropic or hypermetropic. For example, myopic users can exhibitdecrease in foveal cone packing density for myopia as compared toemmetropic eyes. Changes in cone packing density can also be observed inuser's with cone dystrophy and/or retinitis pigmentosa. Maculardystrophy may cause abnormal photoreceptor structure. Accordingly,macular dystrophy can be determined by imaging the photoreceptorstructure of the user.

Various embodiments of the device 2650 configured as a confocalmicroscope, a scanning laser ophthalmoscope, adaptive optics scanninglaser ophthalmoscope and/or two-photon microscope can be configured toperform fluorescence microscopy. For example, a fluorescent dye can beinjected into the blood vessels of the user and fluorescence microscopycan be used to track blood flow in the fundus or retina in real time. Asanother example, a fluorescent dye can be injected into the bloodvessels of the user and fluorescence microscopy can be used to imageindividual capillaries in nerve fiber layer, to determine thickness ofnerve fiber layer and/or to determine vessel patterns in the fundus ofthe eye. In various embodiments, the fluorescent dye can be delivered bya fluid delivery system integrated with the system 2650. As describedherein, the device may include output ports for delivering fluorescentdyes. Accordingly, fluorescence microscopy can be useful to determinechanges in nerve fiber layer thickness or vasculature alterationsresulting from retina damage caused by different diseases of the eye,such as, for example, glaucoma, macular dystrophy, etc. As anotherexample, fluorescence microscopy can be used to analyse lipofuscingranule autofluoresence with simultaneous cone structure imaging andcone/retinal pigment cell ratio analysis to track retinal damage fromretinal dystrophies. As yet another example, light damage to macula fromparticular wavelengths can be observed by fluorescence microscopy.

The ophthalmic system 2650 can be configured for non-health applications(e.g., for entertainment such as watching movies or videos, playinggames, for work, etc.) as well as a confocal microscope, a scanninglaser ophthalmoscope, adaptive optics scanning laser ophthalmoscopeand/or two-photon microscope. The system 2650 can be configured toperiodically (e.g., hourly, daily, weekly, bi-weekly, monthly,bi-annually, annually, etc.) perform confocal microscopy. In variousembodiments, the system 2650 can be configured to perform confocalmicroscopy of the eye 2620 at irregular time intervals. For example, thesystem 2650 can be configured to perform confocal microscopy, a scanninglaser ophthalmoscopy, adaptive optics scanning laser ophthalmoscopyand/or two-photon microscopy a few times an hour, a few times a week, afew times a month, a few times a year, etc. Accordingly, such anexamination can be completed 1, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24 or moretimes a year. Such an examination may be performed more often if a userhas a health problem. The system 2650 can be configured to performconfocal microscopy, a scanning laser ophthalmoscopy, adaptive opticsscanning laser ophthalmoscopy and/or two-photon microscopy if the system2650 detects that the user 2660 is having difficulties with vision or ishaving difficulties in focusing. The system 2650 can also be configuredto be used in a doctor's office or a hospital as a confocal microscope.However, the ophthalmic system 2650 can be worn by a user 2660.

Autorefractor

In one or more embodiments, the ophthalmic device may be configured tofunction as an autorefractor. An autorefractor provides an objectivemeasurement of a person's refractive error. In contrast to a phoropterwhich requires subjective responses from the patient, the autorefractordoes not rely on responses from the user. A cycloplegic agent (e.g., eyedrops) may be used to keep the ciliary muscles in a relaxed position,resulting in a loss of accommodation of the user. This relaxed positionof the eye provides for a more consistent view of the retina. Thepatient may be asked to view an image projected inside the autorefractordevice. The image may move in and out of focus across depth planes asthe machine takes readings to determine when the image is on the retina.The machine may average the results to determine a prescription.

To this end, the ophthalmic device may use the FSD to provide one ormore images at varying depths, and scanning, through an eye-scanningmodule, to capture images of the retina while the eye is focused at theimages of varying depths. As was the case in previous examples, variousalgorithms may be used to determine when the patient properly focuses onthe image, and subsequently determine an optical prescription for theuser. The processor of the ophthalmic device may be used to perform anumber of objective refractive examinations using visible or infraredlight. In one or more embodiments, image quality analysis/contrast peakdetection techniques may be used in analysis. Similarly, the Scheinerdouble pinhole alignment. Shack-Hartmann grid alignment and/or theretinoscopic reflex neutralization may be used as well.

FIG. 26A illustrates an example embodiment of an augmented and/orvirtual reality system 2600 configured as an autorefractor. In someembodiments, the system 2600 includes a stacked waveguide assembly 178,an adaptable optics element, such as a variable focus element (VFE)(e.g., a deformable mirror membrane whose shape is controlled byelectrical signals applied to a plurality of electrodes) or an opticalelement that can otherwise alter its optical characteristics in acontrolled manner, or any combination of the same. Examples of such aredisclosed herein with respect to FIGS. 10A-10D. The system 2600 may alsoinclude a beamsplitter 2602, a camera 2604, a processor 2606, and apositive lens 2608. The system 2600 can be head-mounted so as to bealigned with a user's eye 58. Although the autorefractor system 2600 isillustrated for a single eye, it could also be a binocular autorefractorcapable of testing the refraction of both eyes of a patientsimultaneously. The system 2600 can also include any of the otherelements or features described herein. In some cases, the additionalelements which are used in autorefractor embodiments but which would notnecessarily be required for other functions described herein can beprovided as add-on attachments to an augmented and/or virtual realitysystem.

The stacked waveguide assembly 178 can be used to transmit light withvarying amounts of wavefront curvature to the eye 58. For example, thestacked waveguide assembly 178 can transmit light beams to the eye 58with different amounts of vergence, including light beams with positivevergence or negative vergence, as well as collimated beams.

The stacked waveguide assembly 178 can include multiple waveguides (182,184, 186, 188, 190) and multiple lenses (192, 194, 196, 198). In someembodiments, the lenses (192, 194, 196, 198) are negative lenses. Asshown in FIG. 26A, the waveguides and negative lenses can be arranged inan alternating stacked configuration. The stacked waveguide assembly 178also includes a plurality of light sources (200, 202, 204, 206, 208). Asdiscussed herein, these light sources can be fiber scanning displays,though other light sources can also be used. Each respective lightsource can inject light into a corresponding waveguide (182, 184, 186,188, 190), which distributes the light substantially equally across itslength and redirects the light toward the eye 58. In some embodiments,the light sources (200, 202, 204, 206, 208) can inject collimated lightinto the respective waveguides (182, 184, 186, 188, 190) and each of thewaveguides can output collimated beams of light at a range of differentoutput angles. The light provided by the light sources (200, 202, 204,206, 208) can be in the visible or infrared spectrum.

In some embodiments, the first waveguide 182 nearest the eye 58 may beused to deliver light beams with positive vergence to the eye. This maybe accomplished by, for example, providing a positive lens 2608 betweenthe first waveguide 182 and the eye 58. The positive lens 2608 canimpart a degree of positive vergence to all of the light beams whichpass through it. FIG. 26B illustrates an example of a light beam withpositive vergence being transmitted to the eye 58. As just discussed,this positive vergence beam can result from light originating at thefirst waveguide 182.

The remaining waveguides (184, 186, 188, 190) may deliver light beams tothe eye 58 with different amounts of vergence. For example, the secondwaveguide 184 in the stack can be used to provide light beams with alesser degree of positive vergence than the first waveguide 182 in thestack. This can be accomplished, for example, by transmitting light fromthe second waveguide 184 through a negative lens 192. The negative lens192 imparts a degree of negative vergence to the beams of light whichpass through it, thus causing such beams to have relatively lesspositive vergence when compared to those which are output from the firstwaveguide 182 in the stack.

In a similar fashion, the third waveguide 186 in the stack can be usedto provide light beams with a lesser degree of positive vergence thanthose which are output from the second waveguide 184 in the stack. Forexample, the third waveguide 186 can be used to provide collimated lightbeams with zero vergence to the eye 58. This can be accomplished bytransmitting light from the third waveguide 186 through both the firstnegative lens 192 and an additional negative lens 194. Each of thesenegative lenses (192, 194) impart a degree of negative vergence to thebeams of light which pass through them, thus causing them to haverelatively less positive vergence when compared to those which areoutput from the first or second waveguides (182, 184) in the stack. FIG.26C illustrates an example of a collimated light beam with zero vergencebeing transmitted to the eye 58. As just discussed, this collimated beamcan result from light originating at the third waveguide 186.

The fourth waveguide 188 in the stack can be used to provide light beamsto the eye 58 with an even lesser degree of positive vergence than thosewhich originate from the first, second, and third waveguides (182, 184,186) in the stack. For example, the fourth waveguide 188 can be used toprovide light beams with a degree of negative vergence to the eye 58.This can be accomplished due to the fact that beams of light which exitfrom the fourth waveguide 188 travel through one additional negativelens 196 as compared to beams of light which are output from thepreceding waveguides in the stack.

Finally, the fifth waveguide 190 in the stack can be used to providelight beams with an even greater degree of negative vergence as comparedto those which originate from the fourth waveguide 188. Once again, thiscan be accomplished by transmitting light beams which are output fromthe fifth waveguide 190 through yet another negative lens 198 along theoptical path to the eye 58. FIG. 26D illustrates an example of a lightbeam with negative vergence being transmitted to the eye 58. As justdiscussed, this negative vergence beam can result from light originatingat the fifth waveguide 190.

The stacked waveguide assembly 178 can also include a compensating lenslayer 180. This lens layer can compensate for the cumulative effect ofthe negative lenses (192, 194, 196, 198) when the user is viewing lightfrom the outside world 144 on the other side of the stacked waveguideassembly 178. The compensating lens layer 180 can also be designed tocompensate for the positive lens 2608 provided between the stackedwaveguide assembly 178 and the user's eye 58 (if such a positive lens ispresent).

As just described, the waveguides in the stacked waveguide assembly 178can be used to controllably provide beams of light to the eye 58 with arange of different vergences, from beams with positive vergence tocollimated beams to beams with negative vergence. Although theembodiment has been described from the perspective that the output beamwith the greatest degree of positive vergence originates from the firstwaveguide 182 while the output beam with the greatest degree of negativevergence originates from the last waveguide 190, this could be reversedby appropriate selection of the lenses (192, 194, 196, 198, 180, 2608).Furthermore, it is not necessarily required that the system be capableof outputting beams with positive vergence, negative divergence, andzero vergence; some systems may only output beams having a subset ofthese possible vergences. Finally, although the illustrated stackedwaveguide assembly 178 includes five waveguides, other embodiments caninclude additional waveguides in order to provide light beams with agreater range of vergences and/or finer steps between the availablevergences. Alternatively, other embodiments could include fewerwaveguides in order to simplify the device, reduce cost, etc.

With reference back to FIG. 26A, the beams of light which are outputfrom the stacked waveguide assembly 178 propagate toward the user's eyealong the visual axis. In the illustrated embodiment, these beams aretransmitted through a beamsplitter 2602 which is provided between thestacked waveguide assembly 178 and the eye 58. The beamsplitter 2602 isaligned with the visual axis of the eye 58 and allows the camera 2604 toview the eye 58. Although the beamsplitter 2602 is illustrated as beinglocated between the stacked waveguide assembly 178 and the eye 58, itcould alternatively be located on the opposite side of the stackedwaveguide assembly 178 from the eye 58, and the camera 2604 could viewthe eye 58 through the stacked waveguide assembly 178.

As already discussed, the autorefractor system 2600 can provide imageryto the eye 58 using beams of light with varying degrees of vergence. Asthis imagery is provided to the eye 58, the camera 2604 can be used tomonitor the retina of the eye 58. The camera 2604 can provide retinalimages to the processor 2606. The processor 2606 can then perform imageprocessing algorithms on the retinal images to determine when theimagery projected by the autorefractor system 2600 is best focused onthe retina of the eye 58. Such image processing algorithms can include,for example, contrast peak detection. (Imagery projected on the retinaof the eye 58 will generally have relatively low contrast when theimagery is blurred and peak contrast when the imagery is sharply focusedby the eye 58.) The processor 2606 can calculate the refractive power ofthe eye 58 based on the degree of vergence (whether positive,collimated, or negative) required to allow the eye 58 to focus light onthe retina. The processor 2606 can determine image quality in multiplemeridians in order to calculate not only spherical power of the eye butalso cylindrical power and axis.

The processor 2606 can control the operation of the autorefractor system2600. In one example embodiment, the control method can include causingone or more of the light sources (200, 202, 204, 206, 208) to project animage toward the eye 58 using beams of light having a first vergencevalue (whether positive, collimated, or negative). The processor 2606can then capture an image of the retina of the eye 58 using the camera2604. The processor 2606 can analyze the captured retinal image todetermine a metric of the quality of the image formed on the retina whenusing beams of light having the first vergence value.

The processor 2606 can then cause one or more of the light sources toproject the image toward the eye 58 using beams of light having a secondvergence value that is different from the first vergence value. Theprocessor 2606 can then once again capture an image of the retina of theeye 58 using the camera 2604 and analyze the retinal image to determinea metric of the quality of the image formed on the retina when usingbeams of light having the second vergence value. The processor 2606 canthen compare the first image quality metric with the second imagequality metric. Based on this comparison, the processor 2606 can selecta third vergence value to use when projecting the image toward the eye58 using any of a variety of optimization algorithms. The processor 2606can then calculate a third image quality metric indicative of thequality of the image formed on the retina when using beams of lighthaving the third vergence value. This process can be performediteratively until the image quality metric is maximized or otherwisedetermined to be sufficient. Finally, the processor 2606 can compute therefractive power of the eye 58 based on the vergence value correspondingto this image quality metric. In addition, the processor 2606 caninitiate execution of the phoropter method described herein if theautorefractor system 2600 identifies refractive error(s) above athreshold. The phoropter system can be used as check on the accuracy ofthe measurements by the autorefractor system 2600, or vice versa. Inthis way, the autorefractor system 2600 and the phoropter systemdescribed herein can be used jointly to characterize a patient's vision.

FIG. 26E illustrates another example embodiment of an augmented and/orvirtual reality system 2650 configured as an autorefractor. Theautorefractor system 2650 can include all of the features of theautorefractor system 2600 illustrated in FIG. 26A (though thebeamsplitter 2602, the camera 2604, and the processor 2606 are not shownfor clarity). In addition, the autorefractor system 2650 illustrated inFIG. 26E can include a Scheiner's pinhole disc 2660 located along theoptical path of the system before the eye 58. The Scheiner's disc 2660can be located, for example, between the stacked waveguide assembly 178and the beamsplitter 2602. This is an opaque disc with two or more smallapertures. As illustrated in FIG. 26E, when a collimated beam of lightis incident upon the Scheiner's disc 2660, the beam is blocked frombeing transmitted to the eye except for rays of light which are able topass through the two apertures. In the case of an emmetropic eye, therays of light transmitted through each of the two apertures are focusedto a common spot on the retina of the eye 58. Thus, a retinal imagetaken by the camera 2604 would reveal a single spot.

While FIG. 26E illustrates the effect on an emmetropic eye of acollimated beam passing through a Scheiner's disc 2660, FIGS. 26F and26G respectively show the same effect on a hyperopic eye and on a myopiceye. As seen in FIG. 26F, the optical power of the hyperopic eye is notstrong enough to focus the rays of light transmitted through the twoapertures of the Scheiner's disc 2660 to a single spot. Thus, a retinalimage taken by the camera 2604 would reveal two distinct spots in thecase of a collimated beam illuminating a Scheiner's disc in front of ahyperopic eye. As seen in FIG. 26G, the optical power of the myopic eyeis too strong, which results in the rays of light transmitted throughthe two apertures of the Scheiner's disc 2660 being focused in front ofthe retina. This, too, results in two distinct spots being formed on theretina.

The autorefractor system 2650 can therefore vary the vergence of thebeam of light which is incident upon the Scheiner's disc until a singlespot is formed on the retina of the eye. The refractive power of the eye58 can be calculated based on the beam vergence required to form asingle spot on the retina.

The processor 2606 can control the operation of the autorefractor system2650. In one example embodiment, the control method can include causingone or more of the light sources (200, 202, 204, 206, 208) to project abeam of light having a first vergence value (whether positive,collimated, or negative) onto the Scheiner's disc 2660. The processor2606 can then capture an image of the retina of the eye 58 using thecamera 2604. The processor 2606 can analyze the retinal image todetermine the number of spots which are evident. If only a single spotis evident, the processor 2606 can calculate the refractive power of theeye 58 based on the first vergence value. Alternatively, if multiplespots are evident, the processor 2606 can select a second vergence valuethat is different from the first vergence value. The processor 2606 canthen cause a beam of light having the second vergence value to beprojected onto the Scheiner's disc 2660. The processor 2606 can onceagain capture an image of the retina of the eye 58 using the camera 2604and analyze the retinal image to determine the number of spots which areevident. If a single spot is evident, the processor 2606 can calculatethe refractive power of the eye 58 based on the second vergence value.Otherwise, the third vergence value can be selected and the process canbe iteratively repeated until a single spot is formed on the retina. Theprocessor 2606 can then compute the refractive power of the eye 58 basedon that vergence value.

Any of the autorefractor or other diagnostic methods described hereincan be used for real-time adjustments while the user is watching contentto ensure the content is focused. In addition, monitoring of the user'srefractive error can be performed on a long term basis (e.g., weeks,months, or years) to provide longitudinal monitoring and analysis of theuser's refractive error. The frequency of regularly-scheduled tests maybe automatically adjusted based on trending of the test results or whenthe system detects that the user is have difficulties with vision.

OCT

Various embodiments of the augmented reality/virtual reality wearabledevice that can be worn by a user as described herein can be configuredto function as an optical coherence tomography (OCT) system. FIGS. 23Aand 23B schematically depict a wearable device 2350 that can beconfigured to function as an OCT system. The device 2350 includes aframe 2364 attached to a display system 2362. The display system 2362can be configured to be positioned forward of the eyes 2320 of the user2360. The device 2350 can be configured to project a beam of light 2338from a light source 2354 into the eyes 2320 of the user 2360. A portionof the projected beam 2338 can be reflected, scattered and/or diffractedby various anatomical features of the eyes 2320 of the user 2360 aslight rays 2356 and received by one or more imaging devices 2352. Anelectronic hardware processor 2370 can be used to analyze light receivedfrom the eyes 2320 of the user 2360 to examine the various structures ofthe user's eye 2320.

In various embodiments of the wearable device 2350, the frame 2364 canhave characteristics similar to the frame 64 of FIGS. 3A-3C. In variousembodiments of the wearable device 2350, the display system 2362 canhave characteristics similar to the display system 62 of FIGS. 3A-3C andFIG. 5. In various embodiments of the device 2350, the electronichardware processor 2370 can be similar to the local processing and datamodule 70 of FIGS. 3A-3C.

The display system 2362 of various embodiments of the ophthalmic system2350 can comprise a display lens 2376 mounted in the frame 2364. In someembodiments, the display lens 2376 can be a unitary lens comprising twoocular zones, each ocular zone positioned in front of the user's eyes2320. In some embodiments, the display system 2362 can comprise twodisplay lenses mounted in the frame 2364, each display lens comprisingan ocular zone that is positioned in the front of each of the user'seyes 2320.

The optical source 2354 can comprise one or more LEDs, one or moreflashlamps, one or more superluminescent diodes and/or possibly one ormore lasers. In various embodiments the light source is an incoherentlight source. In some embodiments, the optical source 2354 can be a partof the illuminating system of the device 2350 that is configured toprovide illumination to the display lens 2376 and/or to the eyes 2320 ofthe user 2360. In some such embodiments, the beam 2338 can be projectedfrom the display lens 2376 into the eye 2320 of the user 2360. Forexample, the optical source 2354 can comprise a fiber scanning device(FSD) and the display lens can comprise a plurality of waveguides havingcharacteristics similar to the waveguide stack 178 described above withreference to FIG. 10D. Light from the FSD can be injected into one ormore of the plurality of waveguides and emitted from the one or more ofthe plurality of waveguides into the eye 2320 of the user to perform OCTfunctions. The plurality of waveguides of the display lens can becoupled with adaptive focusing elements that can change characteristicsof the wavefront emitted from the plurality of waveguides.

In some embodiments, the optical source 2354 can be an auxiliary opticalsource disposed on a side of the display system 2362. In suchembodiments, the wearable device 2350 can include optical components,such as, for example, lenses or other refractive components, reflectivesurfaces, deflectors, reflectors, beam splitters, diffractive opticalelements, waveguides, or other optical components, etc. to direct thebeam 2338 towards the wearer's eye 2320. For example, the optical source2354 can comprise an additional FSD and the display lens can comprise anadditional stack of waveguides. Light from the additional FSD can beinjected into one or more waveguides of the additional stack ofwaveguides and emitted from the one or more waveguides of the additionalstack of waveguides into the eye 2320 of the user to perform OCTfunctions. The waveguides in the additional stack of waveguides can becoupled with adaptive focusing elements that can change characteristicsof the wavefront emitted from the additional stack of waveguides. Asdiscussed in detail below, the beam 2338 from the optical source 2354can be incident on a desired region of the wearer's eye 2320. The beam2338 can be scanned along x-, y- and z-directions across the desiredregion of the wearer's eye 2320 to two/three-dimensional images of thedesired region.

The wearable device 2350 configured as an OCT system can include aninterferometer and can obtain sub-surface images of translucent oropaque materials (e.g., various structures in the user's eye 2320,various ophthalmic tissue in the user's eye 2320) at a resolutionequivalent to a low-power microscope. The system can be configured touse light imaging reflections from within the tissue to providecross-sectional images to produce micrometer resolution 3D images. Invarious embodiments, light from the optical source 2354 can generate theprojection optical beam 2338 that is directed at the tissue, and areference beam that is directed towards a reflective reference such as amirror or reflective element. A small portion of this light thatreflects from the sub-surface features of the tissue to which theprojection optical beam 2338 is directed as light rays 2356 is collectedand interfered with light reflected from the reflective reference.Interferometry techniques may be used to record the optical path lengthof received photons, thereby allowing rejection of most photons thatscatter multiple times before detection.

In various embodiments, a beam splitter can be disposed in the opticalpath of light emitted from the optical source 2354 to generate theprojection beam 2338 and the reference beam. As shown in FIG. 23A-1, inembodiments of the device 2350 in which the optical source 2354comprises a FSD, a fiber splitter/coupler can be used to generate theprojection beam 2338 and the reference beam and to combine lightscattered or back reflected from the various structures in the eye 2320and the reflected reference beam. In various embodiments, the reflectivereference can be a movable reflector. FIG. 23A-1 also shows a lightguide with turning features in a wave guide stack that may be used todirect the OCT light beam to the eye and to receive light returnedtherefrom. This waveguide guide may be included in a waveguide stacksuch as the waveguide stack configured to project images to the eye asdescribed herein. The inset shows the fiber coupler used to couple lightinto the reference arm and reflect from the movable reference reflector(e.g. movable mirror) as well as the detector that receives both thelight reflected from the reference reflector as well as the lightreturned (e.g., reflected or backscattered, etc.) from the eye.

As discussed above, in some embodiments an incoherent light source suchas an LED (e.g., superluminescent LED) may be used. Such a light sourceprovides the interferometer with a reduced coherence length. As aresult, the OCT instrument has a short depth of focus or region fromwhich light is collected to image. This region can be scanned in thelongitudinal direction (z), along the direction of the beam, to producewhat is referred to as an A scan. Additionally, a small spot size of thebeam that is incident on the eye may provide for reduced lateralresolution. Again the beam can be scanned orthogonal to the longitudinaldirection, in the lateral directions (x and y), to generate B and C scanand thus create 2D and 3D images showing the tissue and structure of theeye.

The region can be scanned in the longitudinal direction (z direction) bychanging the position of the reflective reference, the wavelength of theprojection beam 2338 and/or the reference beam or the angle between theprojection beam 2338 and the reference beam, which changes the opticalpath length difference between the projection beam 2338 and thereference beam. Varying the optical path length difference between theprojection beam 2338 and the reference beam can advantageously allow thedevice 2350 configured as an OCT system to build clear 3D images ofthick samples by rejecting background signal while collecting lightdirectly reflected from surfaces of interest.

In one or more embodiments of the device 2350, the optical source 2354can comprise a FSD that can serve as a 3D scanning head configured notonly to project light beams but also to receive light beams 2356backscattered from the eye. In one or more embodiments light beams ofvarying wavelengths (i.e., other than visible light spectrum) may beprojected (e.g., through FSD or other optical sources) to provideadditional 3D resolution. The OCT system may comprise a time-domain orfrequency domain OCT. In various embodiments, the device 2350 can beconfigured as a Spectral (Fourier) Domain OCT which can simultaneouslyreceive and measure reflected/backscattered light from the eyecomprising a plurality of wavelengths in a spectral range.

In various embodiments, the optical source 2354 can comprise a scanninglaser device that outputs an illumination beam having a spot sizebetween about 1 micron and about 1.0 mm. For example, the illuminationbeam can have a spot size between about 1-3 microns, between about 2-10microns, between about 5-25 microns, between about 10-30 microns,between about 20-100 microns, between about 50-200 microns, betweenabout 75-250 microns, between about 100-300 microns, between about225-500 microns, between about 375-600 microns, between about 500-750microns, between about 650-850 microns, between about 725 microns-1 mm,or any values in these ranges or sub-ranges. The scanning laser devicecan be configured to scan across a desired area of the eye in a desiredscan pattern. The scanning laser device can be configured to scan at aspeed between about 1 kHz and about 5 MHz to generate the desired scanpattern. Accordingly, the desired scan pattern generated at the desiredarea of the eye can be considered to comprise a plurality of pixels thatare illuminated serially (e.g., one at a time) over the scan period. Insome such embodiments, the one or more imaging device 2352 can include aphotodetector that is configured to receive back scattered or backreflected light from each of the plurality of pixels. The intensity ofthe light received by the photodetector can be correlated to the scanangle and/or position of the illumination beam to generate atwo-dimensional image of the desired area.

The light projected from the optical source 2354 can be focused atdifferent focal distances in the wearer's eye 2320. For example, thefocus of the projected light can coincide with the cornea, the iris, thenatural lens, the vitreous or the retina. In various embodiments, one ormore adaptable optical elements or variable focusing elements (VFEs) canbe optionally used to change the angle of incidence of the lightprojected from the optical source 2354 and/or the focal plane at whichthe light projected from the optical source 2354 is focused or appearsto originate, as discussed above with reference to FIGS. 10B, 10C and10D. For example, light output from the optical source 2354 can bemodified using optical systems comprising lenses, prisms and/or mirrors(e.g., optical element 1024 of FIG. 10C) such that the depth at whichthe beam 2338 is focused in the eye and/or the direction of the beam2338 on the eye 2320 of the user 2360 can be varied.

In various embodiments, the VFEs can include deformable mirror devices.For example, the VFEs can comprise one or more electrodes coupled to amembrane mirror. A control system can be configured to selectivelycontrol the one or more electrodes to modify a shape of the membranemirror. Accordingly, the wavefront of the light emitted from the stackedwaveguide assembly can be modified by the modifying the shape of themembrane mirror. Embodiments of the wearable device 2650 that do notinclude an optical source comprising a scanning laser device or a fiberscanning device can include deformable mirror devices to steer the beamand/or to vary the depth at which the beam is focused within the user'seye. In various embodiments, the VFE's can comprise deformable lenses.The deformable lenses can comprise an elastomeric material that can bedeformed by application of electrostatic energy to create lenses orlenticular surfaces with different curvatures. In some embodiments, theVFE's can comprise lenses that can be deformed with activation ofelectrodes. Some lenses can vary refractive index with application ofvoltage to electrodes (e.g., liquid crystal lenses). In variousembodiments, the device 2350 can comprise spatial light modulators thatmodulate the phase. Embodiments of the wearable device 2650 that includean optical source comprising a scanning laser device or a fiber scanningdevice can include deformable lenses and/or spatial light modulatorsthat modulate phase to steer the beam and/or to vary the depth at whichthe beam is focused within the user's eye.

In various embodiments, the optical source 2354 can be configured togenerate a white light or a colored light comprising a range ofwavelengths of the visible spectral region. For example, the opticalsource 2354 can generate a light of any color having wavelengths in therange between about 440 nm and about 510 nm; between about 460 nm andabout 550 nm; between about 490 nm and about 560 nm; between about 530nm and about 610 nm; between about 550 nm and about 620 nm; or a valuein any of these ranges or sub-ranges.

In some embodiments, the optical source 2354 can be configured togenerate an infrared light comprising one or more wavelengths in a rangeof wavelengths in the infrared spectrum of light. For example, theprojection beam 2338 can comprise one or more wavelengths in the nearinfrared spectrum of light; in the mid infrared spectrum of light and/orin the far infrared spectrum of light. As another example, theprojection beam 2338 can comprise one or more wavelengths between about700 nm and about 1.5 μm; between about 1.0 μm and about 2.3 μm; betweenabout 1.8 μm and about 3.2 μm; between about 2.4 μm and about 5.8 μm;between about 3.2 μm and about 7.0 μm; and/or between about 6.0 μm andabout 13.0 μm.

The penetration depth of the projection beam 2338 in the eye 2320 of thewearer 2360 can depend on the wavelengths included in the projectionbeam 2338. Additionally, the optical path length difference between theprojection beam 2338 and the reference beam can also depend on thewavelength. Accordingly, varying the wavelengths included in theprojection beam 2338 can advantageously allow imaging of structure andanatomical features at different depths in the eye 2320 of the user2360.

The device 2350 can be configured to image the retina and/or variousretinal layers by varying the depth of the projection beam 2338. Ameasurement of the thickness of the retina and/or various retinal layerscan be obtained from these images. The measurements of the thickness ofthe retina and/or various retinal layers can be used for posterior poleasymmetry analysis (PPAA) that maps retinal thickness across theposterior pole and graphs asymmetry both between hemispheres and betweenthe eyes. Accordingly, the device 2350 can be used to compare thicknessof the retina and/or various retinal layers of one of the user's eye2320 with thickness of the retina and/or various retinal layers for anaverage healthy eye and/or with thickness of the retina and/or variousretinal layers for another of the user's eye 2320.

The device 2350 can be configured to image the macula of the wearer'seye 2320. The macula images can be useful to measure thickness of themacula as discussed above. The macula images can also be useful todetermine swelling of the macula. This can be advantageous in earlydetection of glaucoma—which causes structural changes in the maculabefore functional changes. For example, glaucoma can cause loss ofretinal ganglion cells, changes in the inner plexiform layer, thinningof certain retinal layers, etc. These structural changes can bedetermined from the images of the retina and/or macula.

The device 2350 can be configured to image the lens of the wearer 2360so as to determine accommodation state based on the shape of the frontand back surface and/or thickness of the lens and/or measure refractiveerror. For example, the wearer 2360 can be made to focus on targets atdifferent depths by projecting the beam 2338 from different depthplanes. The changes in the accommodation state of the lens as well asthe size and acuity of the images formed on the retina and/or seen bythe wearer 2360 can be imaged to determine refractive errors. Suchmeasurements can be useful in performing phoropter tests, monitoringrefractive state of the eye or assisting in performing tests that cancorrect refractive errors.

Various embodiments of the one or more imaging devices 2352 can includeone or more wavelength filters configured such that the imaging devices2352 can selectively receive light at one or more desired wavelengthranges from the eye 2320 of the wearer 2260 while attenuating orfiltering out other wavelengths. For example, the imaging devices 2352can include one or more wavelength filters configured such that theimaging devices 2352 can selectively receive light in visible spectralrange, near infrared spectral range, mid infrared spectral range and/orfar infrared spectral ranges. As another example, the imaging devices2352 can include one or more wavelength filters configured such that theimaging devices 2352 can selectively receive light between about 440 nmand about 12.0 μm; between about 500 nm and about 10.0 □nm; betweenabout 550 nm and about 8.5 □m; between about 600 nm and about 5.0 □m;between about 650 nm and about 3.0 □m; between about 1.0 □m and about2.5 □m or any values in the above-identified ranges and sub-ranges whileattenuating or filtering out wavelengths outside of the selected range.

The information and/or images captured by the one or more imagingdevices 2352 may be processed in real-time or later. In variousembodiments, the device 2350 can include optical sources and detectorsthat track the movement of the eye. The optical sources and detectorsthat track the movement of the eye can have characteristics similar tothe source 26 and cameras 24 described with reference to FIG. 5. The eyetracking optical sources and detectors may be used to cancel out anyeffects of eye movement. The wearable device 2350 configured as an OCTsystem may be used to provide a superior in-vivo-wide-fieldmicro-angiography imaging device, in one or more embodiments.

The wearable device 2350 configured as an OCT system, may be used tovisualize retinal topography, deep fundus imaging (i.e., detectinglesions), retinal pigment epithelium (RPE) changes and other age relatedmacular degeneration, visualize retinal vasculature, visualize bloodflow in the fundus of the eye, visualize shape and structure of bloodvessels in the fundus of the eye, etc. The wearable device 2350 may alsobe used to provide a multi-spectral image comparison, which can beadvantageous in improving visual discrimination of retinal andsub-retinal features through spectral and depth enhanced differentialvisibility.

For example, the device 2350 can be configured to perform OCTangiography. Accordingly, the device 2350 can be used to visualize bloodflow in the retina and/or choroid capillary network. Visualizing bloodflow in the retina and/or choroid capillary network can be advantageousin detecting growth of abnormal blood vessels by using the motion ofblood as contrast. Visualizing blood flow in the retina and/or choroidcapillary network using OCT angiography techniques can image multiplelevels of vascular tree in the retina, such as, for example, radialperipapillary capillary level, superficial level and deep plexus levelwithout using fluorescent dyes. The device 2350 can also be used performmulticolor analysis of the retina and/or segmentation of the retinallayers.

As discussed above, the wearable device 2350 may be configured to notonly project light associated with visible light (usually done throughRGB sources), but may also be configured with other multi-spectralcomponents (e.g., laser sources, infrared sources, LED light etc.) toemit light having a range of wavelengths and spectral compositions. Or,in other embodiments, tunable lasers may be used (e.g., cavity lengthmay change in the laser or diffractive gratings may be modified) thatare capable of changing the wavelength of light over time, on aframe-sequential basis, line-sequential basis, pixel by pixel basis,etc.

Multi-spectral light emission may be advantageous for imaging purposesbecause different parts of the eye may react better to other colors orspectra of light, leading to more accurate imaging techniques. Thus, thewearable device 2350 configured as an OCT system may comprise additionalcomponents that enable emission of multi-spectral light. For example,the device 2350 can be configured to perform spectral (Fourier) domainOCT.

In one or more embodiments, the wearable device 2350 may transmit lightof different wavelengths from multiple angles to penetrate the softtissue at the back of the eye. The wearable device 2350 may compriseoptical sources that can provide laser tomography, as well as whitelight tomography. Similarly, ERG (Electroretinography) or EOG(Electrooculography), gaze tracking and computational capabilities mayadvantageously allow the wearable device 2350 to collect, de-noise andprocess light returning from the retinal tissue with precision. If forexample ERG or gaze tracking detect movement of the eye duringmeasurement, the system may discard or filter the data or process thedata differently. Such processing could be to enhance or improve theimage. Other sensors or sensing systems such as accelerometers, motionsensors, headpose tracking devices, etc, may be employed to determine ifthe user moved and introduced vibration into the measurement and/orcaptured image.

FIG. 23C illustrates an example flowchart 2300 of a method of examiningthe eye using the wearable device 2350. The method of examining the eyecan be executed by the electronic hardware processor 2370 in conjunctionwith the wearable device 2350. The device 2350 can be configured performan OCT examination of the eye if the device 2350 detects that the user2360 is having difficulties with vision or trouble focusing. Referringnow to FIG. 23C, an example process flow 2300 is provided. At block2302, an OCT program may be initiated. At block 2304, one or more beamsof light may be projected to a portion of the user's eyes using theoptical source 2354. At block 2306 backscattered light 2356 and/orreflected reference beam can be collected by the optical fibers of a FSDthat is employed as the optical source 2354 or other imaging devices2352 (e.g., photodetectors) to measure a set of parameters associatedwith backscattered light 2356 emitted back from the eye. At block 2308,the system may be configured to extrapolate an image of the portion ofthe user's eye 2320 based on the measured set of parameters associatedwith backscattered light 2356. At block 2310, eye movements may bemeasured and used to de-noise the extrapolated image and to produce amore accurate image. At block 2312, any abnormalities of the eye 2320may be detected from the obtained images and communicated to a clinicianor doctor. For example, the obtained images can be compared with storedimages accessible by the electronic hardware processor 2370 usingpattern matching algorithms to detect abnormalities. The stored imagescan comprise images of healthy eyes, images that show characteristics ofeye affected with particular diseases and/or images of the user's eyesobtained from past examinations. The electronic hardware processor 2370can be configured to obtain quantitative measurements (e.g., volumetricmeasurements) of various parts of the obtained images of the user's eye.The quantitative measurements can be transmitted to a clinician forfurther analysis. As another example, one or more parameters can beextracted from the obtained images to detect abnormalities. The obtainedimages and/or the quantitative measurements can be used to monitor eyehealth or disease progression.

Referring now to FIG. 23A, a schematic of the wearable device 2350 thatuses photodetectors 2352 to perform an OCT function is illustrated. Asshown in FIG. 23B, a light source 2354 directs a projection beam 2338into the user's eyes 2320. The light rays pass through the user's corneaand iris and reach the user's retina. It should be appreciated that theangle at which the light source 2354 projects the light may be variedbased on the areas of the retina or the eye space that need to imaged.As shown in FIG. 23A, some of the light rays (e.g., visible light. RGBlight, IR light, multi-spectral light) that are projected into the eye2320 are backscattered as light rays 2356 and are captured byphotodetectors 2352 that may be positioned at various parts of thewearable device 2350. For example, the photodetectors 2352 may bepositioned all around the rim of the wearable device 2350, around theperiphery of the frame of the wearable device 2350 or any other suitableconfiguration, as shown in FIG. 23B. A reference beam generated by theoptical source 2354 that is reflected from a reflective reference canalso be received at the photodetectors 2352 and interfered with thebackscattered light 2356 to obtain an OCT signal.

One or more parameters of the light received by the photodetectors 2352(e.g., density, angle, intensity, spectral content, etc.) and/or the OCTsignal may be communicated by the photodetectors 2352 to a processor2370 that may use one or more algorithms to extrapolate an image fromthe data transmitted from the photodetectors. In one or moreembodiments, the photodetectors may comprise photo-diodes (e.g.,silicon-based, Germanium-based for IR light, photomultiplier tubes(PMTs), charge-coupled devices (CCDs). CMOS based sensors, Shack-Hartmanwavefront sensors etc.). In one or more embodiments multi-mode fibersmay be used to receive the backscattered light, and channeling them intoPMTs or any other type of photodetectors.

Although the backscattered light 2356 is illustrated in FIG. 23A ascoming off an angle into the photodetectors 2352 for illustrativepurposes, it should be appreciated that the backscattered light 2356 canreflect back at the same angle at which it was emitted. Thus, someembodiments may include beamsplitters to direct the backscattered lightinto one or more photodetectors (not shown).

It is appreciated that the backscattered light 2356 may come from theretina as shown in FIG. 23A, but the light may also be a Purkinje image(e.g., corneal glint, etc.) reflected off the cornea or any other glintof the eye. Different photodetectors may be more sensitive to differenttypes of light or parameters. For example, some photodetectors may bebetter at tracking corneal glints; such sensors may be strategicallyplaced to detect the corneal glint or Purkinje image. Or, otherphotodetectors may be better at differentiating between various anglesat which light is backscattered from the retina, and may be placed in amanner such that it is optically conjugate to the retina. Thus, thewearable device 2350 can comprise various photodetectors that areconfigured to detect different types (or parameters) of thebackscattered light 2356.

The wearable device 2350 can be configured for non-health applications(e.g., for entertainment such as watching movies or videos, playinggames, for work, etc.) as well as an OCT system. The wearable device2350 can be configured to periodically (e.g., hourly, daily, weekly,bi-weekly, monthly, bi-annually, annually, etc.) perform an OCTexamination or when the device 2350 detects that the user 2360 is havingdifficulties with vision or trouble focusing. In various embodiments,the system 2350 can be configured to perform an OCT examination of theeye 2320 at irregular time intervals. For example, the wearable device2350 can be configured to perform an OCT examination a few times anhour, a few times a week, a few times a month, a few times a year, etc.Accordingly, such an examination can be completed 1, 2, 3, 4, 5, 6, 8,10, 12, 16, 24 or more times a year. Such an examination may beperformed more often if a user has a health problem. The system 2350 canalso be configured to be used in a doctor's office or a hospital as anOCT examination. In contrast to a traditional table/bench top OCTsystem, the wearable device 2350 can be worn by a user 2360. Thewearable device 2350 configured as an OCT system can be lightweight,compact and less bulky than a traditional table/bench top OCT system.

In certain embodiments, the doctor, nurse, technician or other healthcare provider controls the system. Alternatively, the user controls theOCT system. In some embodiments, the system is automated andalgorithmically controlled. For example the timing parameter such aswhen the OCT imaging is conducted is determined by the system. Thesystem may determine that testing should be commences based on anindication, for example, from one of the diagnostic tests described,that the health of the eye has diminished or that an indication of ahealth problem has been detected. Alternatively, the system may simplyfollow a protocol, such as a schedule to undertake testing periodicallyor not periodically, such as discussed above.

Various embodiments of the device 2350 can include alarm systemsincluding components that can provide audible, visual, graphic and/ortactile alerts to the user 2360 prior to the commencement of thetesting, during testing and/or after completion of the testing.Furthermore, the device 2350 can also include components that canprovide audible, visual and/or graphic instructions to the user 2360prior to the commencement of the testing, during testing and/or aftercompletion of the testing.

Aberrometer

In one or more embodiments the ophthalmic device may function akin to anaberrometer. An aberrometer measures precise irregularities in the eye.These aberrations are very unique aberrations particular to eachindividual, similar to fingerprints. The device measures a wavefront asit passes through the eyes. In an eye with no aberrations, the wavefrontwill be flat. In an eye with imperfections, the wavefront will be bentand/or distorted. These microscopic aberrations can distort light as itpassed through the cornea and lens and into the retina. The result mayhave a significant impact on the quality of vision, and may affect depthperception, contrast, color perception, night vision, etc. Identifyingthese aberrations can help produce more accurate prescription eye wear.

In order to identify refractive error, the aberrometer may send out aband of laser light into the eye. The light passes through the corneaand the lens of the eye and is reflected back by the retina. Thereflected light may then be measured by the aberrometer to produce 3Dimages. The aberrometer is typically used while performing laser visioncorrection surgery. The map created by the aberrometer directs thedelivery of laser light that precisely re-shapes the cornea.

In one or more embodiments, the fiber scanning display (FSD) of theophthalmic device may be used to produce light in a desired wavefront.As was the case in previous embodiments, the response of the appliedstimulus may be measured. It should be appreciated that wavefronts ofdifferent frequencies may be applied. Similarly, visible or non-visiblelight may be projected into the eye, to produce the correct resolutionfor the resultant 3D image. In one or more embodiments, the captureddata may be processed to determine any abnormalities, similar to theprocess flow shown in FIG. 23C.

FIG. 27 illustrates an example embodiment of an augmented and/or virtualreality system 2700 configured as a wavefront aberrometer. In someembodiments, the system 2700 includes a stacked waveguide assembly 178,an adaptable optics element, such as a variable focus element (VFE)(e.g., a deformable mirror membrane whose shape is controlled byelectrical signals applied to a plurality of electrodes) or an opticalelement that can otherwise alter its optical characteristics in acontrolled manner, or any combination of the same. Examples of such aredisclosed herein with respect to FIGS. 10A-10D. The system 2700 may alsoinclude a beamsplitter 2702, a wavefront sensor 2710, and a processor2706. The system 2700 can be head-mounted so as to be aligned with auser's eye 58. The system 2700 can also include any of the otherelements or features described herein. In some cases, the additionalelements which are used in wavefront aberrometer embodiments but whichwould not necessarily be required for other functions described hereincan be provided as add-on attachments to an augmented and/or virtualreality system.

The stacked waveguide assembly 178 can include multiple waveguides (182,184, 186, 188, 190) and multiple lenses (192, 194, 196, 198). In someembodiments, the lenses (192, 194, 196, 198) are negative lenses, thoughin other embodiments they could be positive lenses. As shown in FIG. 27,the waveguides and negative lenses can be arranged in an alternatingstacked configuration. The stacked waveguide assembly 178 also includesa plurality of light sources (200, 202, 204, 206, 208). As discussedherein, these light sources can be fiber scanning displays, though otherlight sources can also be used. Each respective light source can injectlight into a corresponding waveguide (182, 184, 186, 188, 190), whichdistributes the light substantially equally across its length andredirects the light toward the eye 58. In some embodiments, the lightsources (200, 202, 204, 206, 208) can inject collimated light into therespective waveguides (182, 184, 186, 188, 190) and each of thewaveguides can output collimated beams of light at a range of differentoutput angles. The light provided by the light sources (200, 202, 204,206, 208) can be in the visible or infrared spectrum, for example. Inother embodiments, still other wavelengths of light could be used.

As discussed herein with respect to other embodiments, the stackedwaveguide assembly 178 can be used, whether alone or in conjunction withone or more additional lenses or adaptive optics, to transmit light withvarying amounts of wavefront curvature to the eye 58. The wavefrontaberrometer system 2700 can likewise use any such arrangement in orderto generate wavefronts of lights having desired characteristics.

The stacked waveguide assembly 178 can also include a compensating lenslayer 180. This lens layer can compensate for the cumulative effect ofthe negative lenses (192, 194, 196, 198) when the user is viewing lightfrom the outside world 144 on the other side of the stacked waveguideassembly 178. The compensating lens layer 180 can also be designed tocompensate for any other optical elements which may be provided betweenthe stacked waveguide assembly 178 and the user's eye 58.

With reference back to FIG. 27, the wavefronts of light which are outputfrom the stacked waveguide assembly 178 propagate toward the user's eyealong the visual axis. In some embodiments, the stacked waveguideassembly 178 outputs a probe beam of light having planar wavefronts, asshown in FIG. 27. The probe beam is transmitted through a beamsplitter2702 which is provided between the stacked waveguide assembly 178 andthe eye 58. The probe beam then enters the eye 58 and is eventuallybackscattered by the retina. As the probe beam propagates through theeye, its planar wavefronts can be affected by irregularities orimperfections in the optics of the eye 58. Such irregularities orimperfections can cause the wavefronts to likewise become irregular.

Once the backscattered probe beam exits the eye, it is reflected by thebeamsplitter 2702 toward a wavefront sensor 2710. As shown in FIG. 27,the wavefronts which exit the eye can become irregular. The specificshape of the aberrated wavefronts is dependent upon the irregularitiesor imperfections in the eye 58. The system can include a relay lenssystem that relays the wavefronts at approximately the pupil plane ofthe eye to the wavefront sensor 2710. The wavefront sensor 2710 iscapable of measuring and characterizing the shape of these wavefronts.

The illustrated wavefront sensor 2710 is a Shack-Hartmann type wavefrontsensor (though any other type of wavefront sensor can also be used). Itincludes an array of lenslets which spatially sample the incidentwavefronts at many different locations. The wavefront sensor 2710 alsoincludes a detector, such as a CCD or CMOS array, located one focallength away from the lenslet array. Each lenslet focuses a spot of lighton the detector. The precise location of each spot on the detectordepends upon the local curvature of the wavefront at the location of thecorresponding lenslet. The detector therefore creates an image whichconsists of an array of spots. This image can be analyzed by theprocessor 2706 to determine the precise location of each spot, which isin turn indicative of the wavefront curvature at the location of thecorresponding lenslet. In this way, the processor 2706 can determine thecurvature of the wavefront at each spatial location sampled by thelenslet array. Based on the shape of a measured wavefront, the processorcan calculate aberrations of the eye, including both lower-order andhigher-order aberrations. These aberrations can be representednumerically as, for example, Zernike coefficients.

Once the processor 2706 has determined the aberrations of the eye 58, itcan output those measurements in, for example, numerical or graphicalform. The measurements can be used to determine a treatment plan for theeye 58, such as a corrective optical prescription. In addition, themeasurements of the aberrations of the eye 58 can be used to control anadaptive optical element which can then be used to project opticallycorrected imagery into the eye 58, thus providing a crisper image to theuser. For example, in some embodiments, the processor 2706 can be usedto control the shape of the wavefronts output by the stacked waveguideassembly as it projects virtual and/or augmented reality imagery intothe eye 58. In this way, the imagery provided to the user can bespecially corrected based upon the aberrations of the user's own eye. Ifthe stacked waveguide assembly 178 is only capable of correctinglower-order aberrations of the eye 58, then a different or additionaladaptive optical element can also be provided in order to correct forhigher-order aberrations. For example, a deformable membrane mirrorwhose shape is controlled by electrical signals applied to a pluralityof electrodes can be used to correct for higher-order aberrations. Sucha deformable membrane mirror could be provided in the optical pathbetween the light sources (200, 202, 204, 206, 208) and the waveguides(182, 184, 186, 188, 190). Many other arrangements and/or adaptiveoptical elements can also be used to correct lower and/or higher-orderaberrations of the eye 58 based on measurements from the wavefrontsensor 2710.

The augmented and/or virtual reality system 2700 illustrated in FIG. 27can also be configured as a light field camera or light field microscopethat can be used to examine the eye of the wearer. As discussed furtherherein, this can be done by including a lens that focuses light at ornear the lenslet array shown in FIG. 27. One advantage of such a deviceis that the light field imagery it captures can be computationallyre-focused at different planes at any time after the light field iscaptured. For example, the device could capture a light field image ofthe wearer's eye. In post-processing, the light field image could befocused on the patient's retina to perform a retinal examination. Thesame light field image could also be focused on any other anatomy of theeye in post-processing.

Conventional cameras reduce a three-dimensional object to a flat,two-dimensional recording of light intensity, as detected from theobject space within the field of view of the camera. This flatteningeffect is a result of imaging, in which light rays originating atdifferent points on an object within the field of view of the camera arefocused by a lens to corresponding points on an image plane. Angularinformation is lost in this process; for example, the light intensityrecorded at a given pixel in a conventional image does not indicate therespective intensity contributions of light rays that originate from thecorresponding point in the field of view with different angularorientations. Instead, the intensity measured at each point in the imageplane is indicative of the combined intensity of the various light raysthat enter the camera with different angular orientations from thecorresponding point in the field of view. Thus, various properties, likedepth, cannot be determined quantitatively from a conventional image.

The flattening from three dimensions to two dimensions in a conventionalcamera significantly limits the information content of the image.Perhaps the simplest consequence of this flattening is ambiguity indepth, with objects behind and in front of the focal plane being blurred(out of focus).

One method of obtaining information regarding the respective intensitiesof light rays with different angular orientations from within the fieldof view is to provide a wavefront sensor, such as a Shack-Hartman arrayof lenslets in proximity to a sensor (e.g., a CCD or CMOS sensor), asshown in FIG. 27. Each lenslet samples a spatially localized region ofthe wavefronts of light that enter the instrument from the field ofview, and allows local angular information to be recorded on the sensor.In this way, the sensor can detect the respective intensity of lightrays that arrive at each lenslet from different angular directions. Thisfour-dimensional information of light intensity at each position (x, y)for each angle (θx, θy) quantifies the light field within theinstrument's field of view.

As mentioned above, the system 2700 illustrated in FIG. 27 can beconfigured as a light field camera or microscope by including a lens inthe optical path of the instrument to focus light at approximately theplane of the wavefront sensor 2710. The lens could be placed, forexample, between the beamsplitter 2702 and the wavefront sensor 2710,though other locations may also be suitable. The stacked waveguideassembly 178 can be used to provide one or more beams of light thatilluminate the eye 58. This light can be back-scattered by the retinatoward the beamsplitter 2702. The light can then be focused by a lens.The lens can be positioned and configured such that its focal plane isat or near the wavefront sensor 2710. The wavefront sensor 2710 can thencollect the four-dimensional information of light intensity at eachposition (x, y) for each angle (θx, θy). This light field informationcan be processed by, for example, the processor 2706 to provide an imagefocused at any desired plane.

Ultrasound

FIG. 24A schematically depicts a wearable device 2450 that can be wornby a user 2460 configured to perform an ultrasonic examination of theeye of the user 2460. The device 2450 includes a frame 2464 attached toa display system 2462. The display system 2462 can be configured to bepositioned forward of the eyes 2420 of the user 2460. Variousembodiments of the wearable device 2450 can comprise an ultrasonicstimulator module to produce an ultrasound-front that provides astimulus to the user's eye 2420. The ultrasonic stimulator module cancomprise a probe 2481 configured to contact parts of the eye (e.g.,upper eyelid, eye orbit, sclera, cornea, etc.). The probe 2481 can beconfigured to be connected to an ultrasonic transmitter 2477 configuredto deliver ultrasonic energy to the eye and an ultrasonic receiver 2479configured to receive ultrasonic energy reflected and/or scattered fromvarious structures. In some embodiments, the probe 2481 can beconfigured to be connected to an ultrasonic transceiver 2475 thatcombines the ultrasonic transmitter and receiver. In some embodiments,the ultrasonic stimulator module can be configured to deliver ultrasonicenergy to various parts of the eye without contacting one or more partsof the eye. For example, the ultrasonic stimulator module can comprisean electromagnetic acoustic transducer (EMAT). The ultrasonic stimulatormodule can comprise one or more ultrasonic transducers that areconfigured to convert the ultrasonic energy reflected and/or scatteredfrom various structures in the eye to electrical signals. The probe 2481can be configured to transmit ultrasound to various regions of the eyeas well as receive ultrasound reflected from various regions of the eye.

Accordingly, the wearable device 2450 may be configured to measure theresponse of the applied stimulus and generate images of the variousstructures of the eye. For example, in various embodiments, the probe2481 may be moveable so as to scan one or more directions. In someembodiments, for example, the probe 2481 can be scanned in two or threedifferent potentially orthogonal directions (such as x and y or possiblex, y and z) to produce a two-dimensional images or three-dimensional. Insome embodiments, as another example, the probe 2481 can be moved totransmit and receive ultrasound energy at different angles to producetwo-dimensional and/or three-dimensional images. Similarly, theultrasound sensor that detects the ultrasound energy can be move orscanned. For example, the ultrasound sensor can be scanned in two orthree different potentially orthogonal directions (such as x and y orpossible x, y and z) to produce a two-dimensional images orthree-dimensional. An electronic hardware processor 2470 havingcharacteristics similar to the local processing and data module 70 ofFIGS. 3A-3C can be used to analyze ultrasound energy received from theeyes 2420 of the user 2460 to examine the various structures of theuser's eye 2420.

The wearable device 2450 may produce more accurate results by reducingnoise that can arise due to clinician movement or interference. In someembodiments, the ultrasound energy may be applied continuously for agiven period of time to perform the ultrasound examination. Alternately,in some embodiments, the ultrasound energy can be applied in apre-determined pattern or protocol unique to the user 2460.

The wearable device 2450 can obtain images of various parts of the eyeincluding the lens, the retina and other structures in the eye fordiagnostic and therapeutic use. For example, ultrasound energy havinglow-power (e.g., ultrasound power less than 2 W/cm²) and/or at lowfrequencies (e.g., ultrasound frequency less than or equal to about 40kHz) can be used to treat glaucoma and/or reduce intraocular pressure(IOP). As another example, high intensity focused ultrasound (HIFU)having energy of about 2 W/cm² and a frequency of about 21 MHz can beused to treat glaucoma or reduce intraocular pressure (IOP). As anotherexample, ultrasound energy having power of between a fraction of 1 W/cm²and about 5 W/cm² and at frequencies between about 1 MHz and about 5 MHzcan be used for cosmetic purposes (e.g., promote collagen productionand/or reduce the appearance of bags under the eyes. Ultrasound stimulican evoke responses in the retina that look qualitatively similar tostrong visual responses but with shorter latency. Different ultrasoundfrequencies including High-frequency ultrasound can be used toaccurately identify a variety of ocular pathologies, including retinaldetachment. For example, ultrasound frequencies of about 8 MHz can beused to obtain A-scans of the eye. As another example, ultrasoundfrequencies between about 10 MHz to 15 MHz can be used to obtain B-scansof the eye.

FIG. 24B illustrates an example flowchart 2400 of a method of examiningthe eye using the device 2450. The method of examining the eye can beexecuted by the electronic hardware processor 2470 in conjunction withthe device 2450. The device 2450 can be configured perform an ultrasoundexamination of the eye if the device 2450 detects that the user 2460 ishaving difficulties with vision or trouble focusing. Referring now toFIG. 24B, an example process flow 2400 is disclosed. At block 2402, anultrasound mode may be initiated. As described earlier, in variousembodiments, a separate ultrasound producing component may be coupled toan AR device. For example, ultrasonic energy can be generated by anultrasonic stimulator module comprising, one or more ultrasonictransducers that is integrated with the augmented reality/virtualreality wearable device 2450 when the ultrasound mode if initiated. Atblock 2404, an ultrasound protocol is determined for the user. Forexample, the ultrasound may be delivered continuously, or may follow aparticular pattern specific to the user. At block 2406, an ultrasoundwavefront or front is delivered to the user's eye. In one or moreembodiments, the response of the eye is measured as illustrated in block2408. For example, the ultrasound waves reflected from variousstructures in the eye can be received by the transducers in theultrasonic stimulator module can be converted to electrical signals.This information can be used to create or generate an ultrasound imageby the device 2450. Any abnormalities of the eye can be detected fromthe generated ultrasound image by a clinician or by an electronicprocessor that can use pattern-matching algorithms to detectabnormalities as illustrated in block 2410.

For example, the obtained ultrasound images can be compared with storedimages accessible by the electronic hardware processor 2470 usingpattern matching algorithms to detect abnormalities. The stored imagescan comprise images of healthy eyes, images that show characteristics ofeye affected with particular diseases and/or images of the user's eyesobtained from past examinations. The electronic hardware processor 2470can be configured to obtain quantitative measurements (e.g., volumetricmeasurements) of various parts of the obtained images of the user's eye.The quantitative measurements can be transmitted to a clinician forfurther analysis. As another example, one or more parameters can beextracted from the obtained images to detect abnormalities. The obtainedimages and/or the quantitative measurements can be used to monitor eyehealth or disease progression.

As illustrated in FIG. 24A, the display system 2462 of the device 2450can comprise a display lens 2476 mounted in the frame 2464. In someembodiments, the display lens 2476 can be a unitary lens comprising twoocular zones, each ocular zone positioned in front of the user's eyes2420. In some embodiments, the display system 2462 can comprise twodisplay lenses mounted in the frame 2464, each display lens comprisingan ocular zone that is positioned in the front of each of the user'seyes 2420. The display lens 2476 using illumination from an opticalsource 2468 can project the generated ultrasonic images to a particularposition of the user's eye 2420. The display lens 2476 can include aplurality of waveguides having characteristics similar to the waveguidestack 178 described above with reference to FIG. 10D. In variousembodiments, the plurality of waveguides can comprise diffractiveoptical elements that are configured to in-couple light output from theoptical source 2468 into one or more of the plurality of waveguides. Theplurality of waveguides can further comprise diffractive opticalelements and/or variable focusing elements that are configured toout-couple light propagating therein. The diffractive optical elementsand/or variable focusing elements can be configured to modify the focalplane and/or the direction of the light projected from the display lens2476 such that the projected images appear to originate from differentdepth planes and different direction. In this mannertwo/three-dimensional images can be projected to a desired position ofthe user's eye. This display lens 2476 may be employed to display theresults of the ultrasound imaging to the wearer. For example, light canbe projected into the eye of the wearer to form images on the retina asdescribed herein so as to present 2D or 3D images corresponding to theultrasound images.

In various embodiments, the optical source 2468 can comprise a fiberscanning device (FSD) that includes a plurality of optical fibersconfigured to transmit light from a light emitter (e.g., laser, LED,flash lamp, superluminescent diodes, etc.) to the display lens 2476. Invarious embodiments, the FSD can be scanned in a variety of patterns(e.g., raster scan, spiral scan, Lissajous patterns, etc.) and speeds.The two/three-dimensional images can also be projected to a desiredposition of the user's eye based by varying the scan pattern and thescan speed of the FSD. As discussed above, in some embodiments, the twoor three-dimensional imaged projected into the eye of the wearer maycorrespond to ultrasound image obtained using the wearable device (e.g.,using the transducers).

In various embodiments, the device 2450 can be configured to performultrasonic stenography. For example, the transducer or ultrasoundsource(s) can be configured to produce high frequency ultrasonic wavesthat are reflected and not absorbed by different structures in the eyeand can be collected by the transducers or sensors or the FSD.

In various embodiments, the system may be configured to performauscultation. In various embodiments, for example, the system mayinclude transducers or sensor that detect and measure ultrasonic energyoriginating from the eye or wearer. Such a configuration can be incontrast to a system that includes a transducer to produce ultrasoundand direct the ultrasound to the eye or wearer and a sensor to detectthe ultrasound that is reflected from the eye or wearer. The ultrasoundsensor can be used to detect or “listen” to ultrasonic energy emittedfrom the wearer such as from blood flow through the vasculature of theeye of the wearer. In various embodiments, the device 2450 can beconfigured to transmit and/or receive energy in audible frequency range.Detecting ultrasonic energy from the wearer's vasculature can, forexample, be used to perform a sound analysis of blood flow in the fundusof the eye.

In various embodiments of the device 2450, the received ultrasoundsignals from the eye can be analyzed to measure a Doppler shift tomeasure velocity of blood flowing in the blood vessels of the retina.Traditional velocity measurements with ultrasound are based on theDoppler principle, which states that sound emitted from a moving sourceor sound reflected from a moving target will lead to a shift in thefrequency of the sound. This so-called Doppler shift can be measureddirectly from the received signal through a continuous wave ultrasoundemission also referred to as CW-Doppler or sampled through the emissionof several ultrasound pulses also referred to as PW-Doppler.

One of the advantages of ultrasound imaging is its ability to measureblood and tissue velocities with high precision and at a high framerate. In the diagnostic setting, information of blood velocities can beused to identify abnormal blood flow related to pathology, such as thejet flow pattern resulting from a heart valve leakage. Further,information about tissue velocities can be used to quantify the functionof the heart, through the identification of areas of the heart musclewith reduced contractibility. Various embodiment of the device 2450configured to perform an ultrasound examination, can be capable ofdetecting ocular murmurs or ocular bruits that can be identified withsubarachnoid hemorrhage, stroke, and carotid-cavernous fistula,symptomatic atherothrombic vascular disease. The device 2450 configuredto perform an ultrasound examination, can be capable of detectingcarotid or renal bruits seen in users with hypertension.

The device 2450 can be configured for non-health applications (e.g., forentertainment such as watching movies or videos, playing games, forwork, etc.) as well as an OCT system. The device 2450 can be configuredto periodically (e.g., hourly, daily, weekly, bi-weekly, monthly,bi-annually, annually, etc.) perform an ultrasound examination. Invarious embodiments, the device 2450 can be configured to perform anultrasound examination of the eye 2420 at irregular time intervals. Forexample, the device 2450 can be configured to perform an ultrasoundexamination a few times an hour, a few times a week, a few times amonth, a few times a year, etc. Accordingly, such an examination can becompleted 1, 2, 3, 4, 5, 6, 8, 10, 12, 16, 24 or more times a year. Suchan examination may be performed more often if a user has a healthproblem or when the device 2450 detects that the user is havingdifficulty in focusing or having trouble with their vision. The device2450 can also be configured to be used in a doctor's office or ahospital as an ultrasound examination.

Electrooculography (EOG), Electroencephalography (EEG), andElectroretinography (ERG)

In various embodiments, the wearable augmented reality device may beintegrated in a system that includes electrodes and electronicsconfigured for EOG (electrooculography). EEG (electroencephalography),and ERG (electroretinography). As shown in FIG. 24F, for example,electrodes (2450) can be positioned around the eye and/or on a person'shead. In some embodiments, the electrodes (2450) can be mounted on theaugmented reality head mounted eyewear, for example, on the frame of theeyewear. One or more of the electrodes may be disposed on an innersurface of the eyewear. Such electrodes may be positioned, for example,on the portions of the eyewear that supports the lens (e.g., rims) orthe temples or earstems, on straps or other support members that supportthe head mounted assembly on the head. Accordingly, these electrodes maybe in contact with the forehead and/or the sides of the head, forexample, above the ear. The electrodes may also be in contact with theeye or face or facial tissue around the eye.

The electrodes (2450) can be connected to wires or leads that aresupported by the frame or main body of the eyewear and/or may beconfigured to be in communication via wireless technology to the device.Accordingly, the electrodes (2450) may be in direct contact with a partof the user's body. The electrodes (2450) may also be disposed at adistance from a user's body, have a particular material or a part of adevice disposed between the electrode (2450) and the user's body, or bedisposed at other locations suitable for measuring electricalpotentials.

The electrodes may be electrically connected to and in communicationwith a local processing and data module (70), a remote processing module(72), and/or a remote data repository (74) in any combination orconfigurations. A voltage measurement may be measured from theelectrodes (2450) and a potential difference for the electrodes (2450)may be determined by the local processing data module (70) or the remoteprocessing module (72). Alternatively, the potential difference may comestraight from a plurality of electrodes (2450). Additional circuitry mayor may not be included on the electrodes or between the electrodes andthe local processing and data module (70).

The remote processing module (72) may be configured to receivemeasurements from the electrodes (2450) and/or send control signals tothe electrodes directly or via the local processing and data module(70). In some embodiments, the local processing and data module (70) mayperform some or all of the transmission of the control signals and thereception of the measurements. Likewise. RF signal conditioning andsignal processing of the measurements can happen in whole or in part inthe local processing and data module (70) and/or in the remoteprocessing module (72). The measurements and the derived parameters ofthe electrodes (2450) may be stored in whole or in part in the localprocessing and data module (70) and/or the remote data repository (74).

Based on the electrical signal measurements from the electrodes (2450),positions of the eye may be determined and thus patterns of the eye maybe detected. In one or more embodiments, the ophthalmic device andsystem may be used and configured for electrooculography (EOG). EOGmeasures the potential voltage between the cornea and Bruch's membrane,which is located at the back of the eye. One primary application is inrecording eye-movement. For EOG, a pair of electrodes can be placed tothe left and right of the eye and/or above and below the eye, asillustrated in the example shown in FIG. 24F. In some embodiments, forexample, the patient may be placed in a well-illuminated room such thatthe patient's eyes are dilated. If the eye moves toward an electrode, apotential difference occurs between the electrodes and the position ofthe eye can be determined, and therefore a measure of eye movement canbe determined. These electrodes may be placed on inwardly facingsurfaces of the eyewear or head mounted device in various embodiments.In some cases, such electrodes may be mounted on padded surfaces on theeyewear. These padded surfaces can be inwardly facing. Such surface maycause the electrode to contact the face (front or side) such as cheek,forehead or temples. In some cases, the electrodes may be adhered to theface (front or side) such as cheek, forehead or temples, and beconnected to the head mounded device by wires or leads. Wirelessconnection to the electronics is also possible as discussed above.Electronics, for example, in any of the configurations discussed aboveor otherwise, can be employed to receive and/or process the EOG signalsto determine eye movement or other conditions.

In one or more embodiments, the ophthalmic device may also comprise EEGsensors to map brain activity. The electrodes (2450) may be placedaround and/or on the user's head to also measure and compare electricalpotentials in this region. The electrodes (2450) may be placed on ahelmet, hat, cap, net, or other housing, frame or surface or surfacesdisposed on or around the head or portions thereof to provide for easeof placement onto a user's head. In some embodiments, for example,straps could be disposed across portions of the head and electrodesmounted on the inner or underside to contact the user's head. Theelectrodes (2450) may also be connected via wireless or wired technologythat is then connected to the ophthalmic device. In certain embodiments,the electrodes (2450) are placed on the back of the wearer's head closerto the optic nerve. Straps, frames, or other flexible or rigid memberscan provide support for one or more electrodes and maybe disposed on aninner surface those members so as to face and contact the head.

The EEG sensors may detect any abnormal activity or pattern in the brainand report out to the user and/or clinician. This may be especiallyuseful for patients immediately after brain surgery or for at-riskpatients. The ophthalmic device may be pre-programmed with an EEGsensing module to analyze data collected by the EEG sensors.Electronics, for example, in any of the configurations discussed aboveor otherwise, can be employed to receive and/or process the EEG signalsand analyze data collected by the EEG sensors.

In one or more embodiments, the ophthalmic device may be configured withelectrodes (2450) that are placed around and/or on the user's eyes tomeasure and compare a resting electrical potential of the retina.Electroretinography (ERG) is the mass electrical response of the retinato photic stimulation, and can measure electric potentials of a varietyof different cell types in the retina. Examples include photoreceptors,inner retinal cells, and ganglion cells. For example, the electrodes(2450) can be placed on the cornea such as via contact lenses, insertedbetween the cornea and the lower eyelid, or the skin near the eye.However, electrodes (2450) can also be placed to record ERG from theskin. The ERG can be placed just above or below the eye, or below theeye next to the lateral canthus. Because the skin electrodes do notcontact the eye, attenuation in ERG signal amplitude will likely bepresent and can be significant. In various embodiments, averaging andother signal processing techniques can be used to increase thesignal-to-noise ratio. A patient's eyes may be exposed to stimuli andthe electrode that is disposed on the cornea measures electricalresponses of cells that sense light in the retina located in the back ofan eye. Generally, when light enters the eye, the light is convertedinto electrical energy by specialized cells in the retina. Stimuli forERG may be flash or patterns, with or without a background light, orvarying colors. Examples include dim flashing (for measuring photopicand/or scotopic rod cell activity), flashing (for measuring cone cellactivity), and/or pattern stimuli (for measuring retinal ganglion cellactivity). ERG electrodes measure electrical activity associate withthis process. Other methods of recording may also be used.

This information may be coupled with optical eye imaging techniques todetect any eye abnormalities. Some such imaging techniques may includethose described herein.

These padded surfaces can be inwardly facing. Such surfaces may causethe electrode to contact the eye or orbital or eye sockets, the face(front or side) such as cheek, forehead or temples or elsewhere. In somecases, the electrodes may be adhered to the eye or orbital or eyesocket, the face (front or side) such as cheek, forehead or temples, andbe connected to the head mounded device by wires. Wireless connection tothe electronics is also possible as discussed above. Electronics, forexample, in any of the configurations discussed above or otherwise, canbe employed to receive and/or process the ERG signals to analyze thesignals.

Accordingly, other imaging and diagnostic as well as treatment toolssuch as descried herein may also be included in the system. The wearableaugmented reality device may comprise a virtual reality device and/or anaugmented reality device. The electrodes may be included in a systemwith the augmented or virtual reality system.

Although electrodes are disclosed, other types of sensors may possiblebe used for EEG, EOG, and/or ERG. The electrodes (2450) may beelectrical conductors able to measure electric potentials, and/or may bea specialized set of unique electrodes for particular tests as describedabove.

Light Therapy

In one or more embodiments, light therapy may be selectivelyadministered to one or more areas of the user's eyes. Light therapyrefers to selective administration of light (e.g., multi-spectral light,blue light, IR, etc.) for various applications. In some embodiments, theamount of one or more wavelengths of light that is projected by ortransmitted through the display (62; FIGS. 3A-3D) into the eyes of theuser may be reduced, or may be increased, depending on application.

In some embodiments, the reduction or increase in the amount of light ofone or wavelengths propagating from or through the display to the eyesof the user may be adjusted dynamically, and may occur in real time,based on the wavelengths of light propagating towards the user's eyesfrom the ambient environment and/or based on the content of images to bedisplayed to the viewer. In addition or alternatively, the reduction orincrease may be determined based on temporal considerations, includingthe time of day, date, time of year, season, etc. For example, bluelight has been found to affect sleep, and the display (62) may beprogrammed to adjust its output of blue light at night, or depending ontemporal proximity to a user's time that the user is anticipated to goto sleep cycle.

As another example, it has been observed that over-exposure to bluelight is especially damaging to retinal cells. The ophthalmic system maybe programmed, in one or more embodiments to detect an overexposure ofblue light through one or more sensors, and to selectively filter outthe blue light to prevent damage to retinal cells. It will beappreciated that the one or more sensors may be the cameras (16) of FIG.5. In some other embodiments, the one of the sensors may be dedicatedcolor sensors facing outward from the frame (108). Filtering out theblue light may involve reducing the amount of blue light projected bythe display system (62) to the user's eyes and/or by having the display(62) filter out or block blue light propagating through the display (62)from the ambient environment to the user's eyes. It will be appreciatedthat “blue light” refers to light of one or more wavelengths that areperceived by a viewer as the color blue and reducing blue light refersto reducing the amount of these one or more wavelengths that reaches theeye or eyes of the user.

In some embodiments, reducing the amount the light of a certain colorprojected by the display system (62) may be accomplished using awavelength selective filter (e.g. a color filter) disposed in the pathof the light to the user's eyes. For example, the filter may be providedat the locations at which the waveguides (182, 184, 186, 188, 190) (FIG.10D) receive light from the plurality of displays (200, 202, 204, 206,208). In some embodiments, the filter may be a coating on a surface ofthe waveguide receiving the blue light from the plurality of displays(200, 202, 204, 206, 208). In some embodiments, the filter may beselectively engaged or disengaged.

In some embodiments, the amount of light of particular wavelengths(e.g., blue light) directed by the display system (62) to the user'seyes may be reduced by reducing the intensity of a light source thatgenerates the light of those waveguides. For example, in someembodiments, the display (62) may be configured to display color imagesusing light sources that output light of wavelengths corresponding todifferent component colors (e.g. red, green, and blue light). Thedifferent component colors, when combined, form a full color image. Insome embodiments, the display (62) may be configured to reduce theoutput of, e.g., the blue light source in cases where blue light is tobe reduced. For example, the local processing module (82; FIGS. 3A-3C)and/or remote processing module (72; FIGS. 3A-3D) may be configured toprovide instructions for the blue light source to output less blue light(e.g., by reducing power supplied to the light source) than mightotherwise be specified to form a full color image. In some embodiments,the amount of light of other wavelengths may similarly be activelyreduced as desired using a filter and/or by reducing the emission oflight of desired wavelengths from a light source.

It will be appreciated that the reduction of the amount of somewavelengths of light reaching the eyes of the user may be triggered byan analysis of the intensity of those wavelengths of light in the imagecontent to be projected to the user's eyes. The display (62) may beprogrammed with a threshold value, above which the display (62) isprogrammed to reduce the output level of selected wavelengths. In someother embodiments, the display (62) may simply be programmed to reduceany output of the particular wavelengths by a set amount. The particularwavelengths and output level may be user selectable or may be programmedby a third party (e.g., a health care provider) as part of a therapyprotocol in some embodiments.

In addition to or as an alternative to reducing the output of certainwavelengths by the display (62), in some embodiments, the display (62)may reduce the amount of light of one or more wavelengths that istransmitted through the display (62) from the ambient environment to theuser. For example, the display (62) may selectively block or occludeparticular portions of the user's field of view to reduce the amount ofthe one or more wavelengths that reaches the eyes of the viewer from theambient environment. A method and apparatus for blocking portions of theuser's field of view may be found in U.S. Patent Application PublicationNo. 2015/0205126, which is incorporated by reference herein. In someembodiments, a light sensor, such as the cameras (16; FIG. 5) may beutilized to detect the level and the originating direction or locationof light of the one or more wavelengths that are incident on the display(62). This information may then be used to block light from thatdirection (e.g., by activating switchable elements in the display (62)),to reduce the amount of the light from that direction that reaches theuser's eyes. In some embodiments, the blocked portion of the user'sfield of view may be replaced by images projected to the user's eyes bythe display (62). These projected images may be an image of the blockedportion of the user's field of view, but with lower levels of the lightof wavelengths to be reduced than that present in the ambientenvironment.

In contrast to overexposure, some studies have found that underexposureto light in general, or light of certain wavelengths, has a profoundeffect on patient's circadian rhythms and has been linked to depression,sleeping disorders, and other mental problems. To this end, theophthalmic system may be similarly programmed to detect an underexposureto light of certain wavelengths, e.g. white light, blue light, or anyother spectrum of light through one or more sensors, and selectivelyadminister (e.g., with a periodic regimen, etc.) light into the user'seyes to correct the imbalance. Many other similar applications may beenvisioned. As noted above, the underexposed wavelengths of light may bedetected using one or more of the cameras (16), or a dedicated colorsensor.

The light may be emitted by any light source (e.g., LED, FSDs, multicorefibers, DLP, OLEDs, IR light sources, etc.). For example, augmentationof the one or more wavelengths of light may be accomplished byincreasing the light output of a light source for those wavelengths oflight (e.g., by increasing the power supplied to a blue-light lightsource, a red-light light source, etc.). In one or more embodiments, theophthalmic system, which includes the display (62), may comprise alight-emitting module 27 (e.g., polychromatic polarized light, lasers,light-emitting diodes, fluorescent lamps, dichroic lamps, full spectrumlight, etc.) to selectively administer light based on a treatmentprotocol. The light-emitting module (27) may function as an auxiliarylight source to output light of desired wavelengths.

It will be appreciated that various forms of light therapy may beadministered through the ophthalmic system. Such light therapy mayconsist of exposure of the eye (or regions of the eye) to daylight orlight associated with specific wavelengths. Depending on the patient'ssymptoms, location, environment (external parameters such as the time ofday, time of year, date, and season), mood, input or any other detectedsign of depression or abnormality, the ophthalmic system may determinethe appropriate treatment protocol. In some embodiments, it will beappreciated that mood and/or mental abnormalities may be detected by theinward facing cameras (24) and/or EEG sensors, as disclosed herein.

Regarding the treatment protocol, light may be administered for aprescribed amount of time periodically or continuously. In someembodiments, the ophthalmic system may also be configured to determinethe wavelength of the light to be administered to achieve a desiredresult. For example, where a need for cell growth and repair isdetermined to be present, the ophthalmic system may be configured toadminister light of wavelengths corresponding to the color red, whichhas been determined to promote cell growth and repair. Other treatmentparameters may be similarly used in determining an efficacious treatmentprotocol. For example, the display (62) may be configured to providefull-spectrum light, or blue and/or green light to the user for a setduration and/or at certain times of day (e.g., morning, include beforesunrise) to treat depression, seasonal affective disorder, and/or toreset circadian rhythms (e.g., due to jet lag). Advantageously, becausethe portability of the display (62) may allow it to be worn by the userthroughout the day, the user's perceptions of the length of days and thetiming and duration of night and daylight may be modified as desiredusing the system (62). For example, full spectrum and/or blue light maybe generated in the morning and/or at night to augment light from theambient to provide the effects of a day having different lengths ordifferent daylight hours. In one or more embodiments, the ophthalmicsystem may be stored with a light therapy program to determine anappropriate protocol.

In one or more embodiments, the ophthalmic system may be used to preventor mitigate age-related macular degeneration (AMD). AMD is a common eyecondition that may cause significant visual loss in affected patients.AMD may be affect patients in either a dry form or a wet form. The dryform generally causes gradual vision loss from deterioration of theretina. The wet form involves the growth of abnormal blood vessels underthe retina called choroidal neurovascularization (CNV). These abnormalblood vessels can leak fluid and/or blood and may affect visualdeterioration.

To this end, the ophthalmic system may comprise one or more componentsfor laser photodynamic therapy to combat AMD and other such relateddiseases. Laser therapy has proven to be beneficial in treating AMD. Theophthalmic system may be configured to determine a location of maculardegeneration, and administer laser treatment or laser photodynamictreatment to the areas most affected by AMD or any other relateddisease. The laser may be administrated such that the growth of abnormalblood cells is mitigated, and in some cases, the laser may help close orreduce the excess blood cells, in the case of wet form AMD.

In one or more embodiments, photodynamic therapy (PDT) may be used toclose abnormal blood vessels caused due to AMD without damaging theoverlying retina. The ophthalmic system may comprise a separate moduleto inject a photo-sensitizing agent (Visudyne) into a vein, which maytravel through the bloodstream and collect in the abnormal vessels underthe retina.

The ophthalmic system may then be configured to administer a low-energylaser (e.g., through a laser module of the ophthalmic system) toactivate the photo-sensitizer. The activated photo-sensitizer results ina chemical reaction that leads to the closure of the leaking bloodvessels.

Macular Degeneration

In one or more embodiments, the ophthalmic system may be configured todetect, diagnose and/or compensate for macular deficiencies. Maculardeficiencies (e.g., holes, cysts, degeneration, etc.) are damages at themacular and foveal tissue in the retina that create anomalies, deadspots or regions of reduced sensitivity to light or devoid ofsensitivity to light in the user's field of view. Common forms ofmacular deficiency include age-related macular degeneration (AMD),Stargardt disease, Best disease, and other degenerative conditions.Age-related macular degeneration includes “dry” AMD, characterized byatrophy of the retinal pigment epithelial layer, and “wet” AMD, in whichvision loss occurs due to complications from abnormal blood vesselgrowth in the retina. Macular deficiencies may result in anomalies, deadspots or regions of reduced sensitivity to light in various parts of thefield of view, as well as loss of contrast or color sensitivity.Frequently, anomalies, dead spots or regions of reduced sensitivityoccur near the center of the field of view rather than at the periphery.

The ophthalmic system may be configured to detect or diagnose maculardeficiencies by determining the ability of a portion of the retina todetect an image. In some embodiments, the ophthalmic system may be auser display device 62 such as shown in FIG. 5, which includes aprojecting subsystem 18 configured to project light 38 into the eye of awearer to form an image in the eye. The user display device 62 includesa display lens 106 which may be mounted to a user's head or eyes by ahousing or frame 108. The display lens 106 may comprise one or moretransparent mirrors or reflective features positioned by the housing 108in front of the user's eyes 20 and configured to reflect projected light38 into the eyes 20 (and also potentially facilitate beam shaping).These reflective surfaces may be partially transmissive to also allowingfor transmission of at least some light from the local environment. FIG.10D also includes another view of an embodiment of a display devicecomprising a plurality of displays 200, 202, 204, 206, 208 that may beutilized to inject image information into a plurality of respectivewaveguides 182, 184, 186, 188, 190, each of which may be configured, asdescribed above, to distribute incoming light across the length of eachwaveguide, for exit down toward the eye. The displays 200, 202, 204,206, 208 may comprise fiber scanning devices (FSDs) to form the image.Such devices can be configured to project an image onto a portion of theretina.

The system can then detect a response from the wearer. For example, theimage may be a small dot that can be clearly seen if projected to ahealthy portion of the retina but likely would not be seen if projectedto a deficient portion. In some embodiments, the wearer may be promptedautomatically or by another user, such as a medical professional, toindicate if the wearer saw an image. The user may then input thewearer's response through a user interface. In some embodiments, theophthalmic system may increase accuracy by using eye tracking cameras 24or similar detection methods to observe if an involuntary reactionoccurs in response to the projection of the image, such as a change infocus or gaze or continued eye scanning, without requiring a consciousinput. Eye tracking cameras 24 may be inward-facing (i.e., directedtoward the users eye) cameras as illustrated in FIG. 5. In someembodiments, the ophthalmic system may directly prompt the wearer toindicate if the image was observed, such as by a manual input or byconsciously directing the wearer's gaze to the image or to a projectedvirtual button image. A virtual button image may be projected by thedisplay lens 106, and the wearer's selection of the button may bedetected by the eye tracking cameras 24 or through gesture recognition.

In some embodiments, the test described above may be repeated atdifferent portions of the retina, or with different images at the sameportion of the retina, to detect areas of macular deficiency. Forexample, a particular portion of the retina where an image can be seenby the wearer may be determined to be healthy, while a portion of theretina where the same image cannot be seen may be determined to bedeficient. In another example, an image consisting primarily of longerwavelength visible light, such as red light, may first be projected. Animage consisting primarily of shorter wavelength visible light, such asblue light, may then be projected to the same portion of the retina, andany disparity in visibility to the wearer may be indicative of a loss ofcolor sensitivity in the wearer. In some embodiments, a plurality ofimages differing in contrast, saturation, hue, intensity, periodicity orspatial frequency, or any other characteristic may be presented to thewearer at different locations on the wearer's retina so as to diagnosevarious sensitivity losses due to macular deficiencies. Images of thewearer's retina may be used in addition to the results of the testingdescribed above to improve the reliability of macular deficiencydiagnosis. Such images may be obtained, for example, by anophthalmoscope or funduscope, optical coherence tomography, or otherimaging technology, various of which are discussed herein.

Macular deficiency testing may be performed in discrete tests on demand,or may be performed periodically and/or repeatedly over time. Repeatedanalysis may allow for the tracking of progressive macular deficiencies,such as age-related or other macular degeneration. Thus, maculardeficiency diagnosis functions may be incorporated into a device wornonly for ophthalmic diagnosis, or may be a part of a device wornregularly, such as for entertainment, work, or other purpose(s), so thatexaminations may be performed automatically at regular intervals and/orat various times of day, week, month, year, etc. In some embodiments,the wearer may be notified before an automatic examination isadministered, such as by an alert sound and/or a visually displayedmessage. Results of macular deficiency testing may be evaluated in realtime at the device for evaluation and/or diagnosis, or may betransmitted via the cloud or other network to be evaluated remotely.Remote evaluation and/or diagnosis of anomalies or other maculardeficiency may be transmitted back to the device to enable the treatmentor compensation methods described below. Unique characteristics of thewearer's eye may be recorded by the device and used for identityverification to ensure the security and privacy of the transmitted data.For example, the camera may image the iris and the processor may performpattern recognition to determine whether the identity of the wearercorresponds to the identity of the person to whom the test resultscorrespond. The system may then display the test results only if thewearer is the person to whom the test results correspond.

The ophthalmic system may help compensate for macular degeneration bydirectly projecting light into the retina and specifically targetinghealthy cells at the periphery of the macula. By changing where light isprojected, the device can selectively target healthy cells and improvethe user's quality of vision. In one or more embodiments, the lightprojecting source comprises a fiber scanning device (FSD) such as afiber scanning display that may be configured to project images via thewaveguides into different portions of the user's eyes. The system maycomprise other types of displays that can be configured to selectivelyproject light onto different portions of the retina. This technology maybe leveraged to selectively project pixels of an image to the healthyretinal cells, and reduce, minimize, or alter the nature of lightprojected to the damaged areas. For example, pixels projected to theanomaly may be magnified or made brighter. It should also be appreciatedthat this technique may also require modifications to the projectedimage data itself, and the processor may alter the nature of the imagesuch that the user does not notice any difference when viewing theimage.

In embodiments comprising an augmented reality device, the system maymodify the wearer's view of light from the world. The augmented realitysystem may detect the light entering the device in real time or nearreal time, and may modify portions of the light or project additionallight to correct for the wearer's macular deficiency. For example, thesystem may use outward-facing cameras to image the world. The system mayproject additional light so as to project an image of the world to thewearer. Pixels may be selectively projected to healthy retinal cells,while pixels projected to anomalies may be reduced, minimized,magnified, brightened, or otherwise altered in magnification, intensity,hue, saturation, spatial frequency, or other quality. The system mayalso be used to generally darken bright rooms and/or brighten nighttimeviews for wearers with difficulty adjusting to changing light conditionsdue to macular degeneration.

A similar method may be used in a virtual reality system. The virtualreality system may have a forward and outward looking camera that imagesthe world in front of the wearer and determines the colors of objects.The virtual reality system may reproduce to the wearer an image of theworld based on the output of the outward-facing cameras, with somemodifications of brightness, magnification, color, and/or otherparameters as described above. For example, the virtual reality systemmay selectively project pixels of the image of the world so as to atleast partially mitigate the macular deficiencies of the wearer.

In augmented or virtual reality systems, the system may use outwardfacing camera(s) to provide alerts to a wearer. Alerts may be based ondetection of hazardous conditions not visible to a wearer due to amacular deficiency. The system may determine the presence of aninvisible hazard based on a correlation of the images from the outwardfacing camera(s) with known macular deficiency data of the wearer, suchas location of anomalies on the retina. When a hazard in a blind spot isdetected, such as an incoming object, a hole in the ground, or othercondition, the system may alert the wearer. Alerts may include visual,audio, or tactile notifications. In cases of complete blindness, thesystem may be configured to detect the presence of a desired item (e.g.,a chair, a table, a bed, etc.) and provide proximity information to thewearer, such as by audible notification.

In one or more embodiments, the ophthalmic system may diagnose orevaluate the user's eye anatomy to determine a location of maculardegeneration. Referring now to FIG. 13, an example process flow 1300 todiagnose, detect, and/or identify any areas of macular degeneration isprovided. At 1302, a macular degeneration diagnosis/evaluation programmay be initiated. As was the case in many embodiments described above,the program may be pre-coded or downloaded into the ophthalmic system.At 1304, an image is projected, through one or more FSDs, to aparticular portion of the user's eye. For example, an image (e.g., asmall dot, a small shape, etc.) is directed to the center of the user'seye (e.g., formed at the center of the retina).

At 1306, the system may receive input, through any type of userinterface, regarding a quality of the image. For example, the user maybe asked to rate a quality of the image from 1 to 10. Or, in anotherembodiment, the image may be projected with increasing or decreasingvisual stimulus, and the user may have to identify when the imageappears or disappears from the user's vision, is reduced in visualstimulus, and/or expresses movement. In some embodiments, the system maydetect the time required for the wearer to answer, as a wearer taking along time to answer may be having difficulty seeing the stimulus.Similarly, many such techniques may be used, such as Pelli Robson orsine-wave grating tests. At 1308, based on the received user's input,the system may determine a health of that portion of the user's eye.

At 1310, the system may determine if other portions of the eye need tobe similarly diagnosed and/or evaluated. If yes, steps 1304-1308 arerepeated. After the various other portions of the eye have beensimilarly tested, at 1312, the results of the health of the variousportions of the user's eye are analyzed, and any anomalies may beidentified.

In one or more embodiments, the AR system behaves like a visuscopecontaining a small graticule target for the measurement of eccentricfixation. The light projecting source (e.g., FSD) may project an imageon the patient's retina, and the patient may be asked to look at thecenter of the target. The position of the foveal reflect relative to thecenter of the graticular target may indicate whether, and to the extentthat, the patient has eccentric fixation. Similarly, a direction anddegree of eccentric fixation may be determined through the aboveprocess.

If it is determined that the user has one or more anomalies, theophthalmic system may be configured to project a modified image to theuser's eye such that the majority of the image is viewed through healthyperipheral retinal cells, and any pixels projected to the anomalies areadjusted. It should be appreciated that the image to be projected mayneed to be modified through predetermined algorithms such that the userviews the image through the healthy cells, but does not notice anychange in the image itself.

Contrast Testing

In one or more embodiments, the ophthalmic system may be configured totest a wearer's contrast sensitivity. Contrast sensitivity testing maybe used to assess a wearer's ability to distinguish different luminancesin an image. Contrast sensitivity testing may indicate the presence ofconditions such as age-related macular degeneration, amblyopia, and/orcataracts.

The ophthalmic system may be configured to administer contrastsensitivity testing by projecting static or changing images. In someembodiments, the ophthalmic system may be a user display device 62 suchas shown in FIG. 5, which includes a projecting subsystem 18 configuredto project light 38 into the eye of a wearer to form an image in theeye. The user display device 62 includes a display lens 106 which may bemounted to a user's head or eyes by a housing or frame 108. The displaylens 106 may comprise one or more transparent mirrors or reflectivefeatures positioned by the housing 84 in front of the user's eyes 20 andconfigured to reflect projected light 38 into the eyes 20 (and alsopotentially facilitate beam shaping). These reflective surfaces may bepartially transmissive to also allowing for transmission of at leastsome light from the local environment. FIG. 10D also includes anotherview of an embodiment of a display device comprising a plurality ofdisplays 200, 202, 204, 206, 208 that may be utilized to inject imageinformation into a plurality of respective waveguides 182, 184, 186,188, 190, each of which may be configured, as described above, todistribute incoming light across the length of each waveguide, for exitdown toward the eye. The displays 200, 202, 204, 206, 208 may comprisefiber scanning devices (FSDs) to form the image. Such devices can beconfigured to project static or changing images of varying contrasts totest a wearer's contrast sensitivity. Such devices may also beconfigured to simulate foreground and background portions of an imagefor purposes of contrast sensitivity testing. Foreground and backgroundmay be projected from different depth planes, or may be simulate by asingle plane. For example, a varying dark foreground plane may beprovided in combination with a bright background plane.

The system can then detect a response from the wearer. For example, theimage may be a high-contrast image that gradually increases or decreasesin contrast. In some embodiments using changing images, the wearer maybe prompted automatically or by another user, such as a medicalprofessional, to indicate when the image appears or disappears, and/orto indicate if the wearer can distinguish between images of differentluminance. In other embodiments using static images, the user may beprompted to indicate the observed content of the image, such as visibleletters, numbers, shapes, or other patterns. The user may then input thewearer's response through a user interface. In some embodiments, theophthalmic system may increase accuracy by using eye tracking cameras 24or similar detection methods to observe if an involuntary reactionoccurs in response to the projection of the image, such as a change infocus or gaze, or a blink. Eye tracking and/or head pose measurement canfurther be used for noise filtering in measured data, as well as toensure that the image is actually projected to the desired part of theretina. Eye tracking cameras 24 may be inward-facing (i.e., directedtoward the user's eye) cameras as illustrated in FIG. 5. In someembodiments, the ophthalmic system may directly prompt the wearer toindicate when the image was observed or when the image disappeared, suchas by a manual input or by consciously directing the wearer's gaze tothe image or to a projected virtual button image. In some embodiments,the wearer may select a virtual button image by looking at a button fora set duration. A virtual button image may be projected by the displaylens 106, and the wearer's selection of the button may be detected bythe eye tracking cameras 24 or through gesture or voice recognition. Insome embodiments, a combination of gaze tracking and gesture recognitionmay be used to detect a wearer response, e.g., the wearer may indicate aresponse by looking at a button and blinking one or both eyes to selectthe button.

In some embodiments, the system may evaluate the wearer's contrastsensitivity using a changing image. An image of relatively high contrastmay be projected to the wearer, and the contrast of the image maygradually be reduced. For example, a dark grey image presented against awhite background may be gradually lightened until the image becomeswhite or nearly white. The wearer may be directed to indicate when theimage can no longer be discerned due to the similarity to the backgroundcolor. The test may be repeated multiple times with the same ordifferent images to gain a more accurate estimate of the wearer'scontrast sensitivity. For example, an image may change to a differentnumber/letter/shape each time it is lightened, and the wearer may beasked to report the number/letter/shape of the image after each change.Color variation between images and/or glare testing (described ingreater detail below) may be incorporated as well.

In some embodiments, the system may evaluate the wearer's contrastsensitivity using a static image. For example, the system may use animage such as a Pelli-Robson contrast sensitivity chart. ThePelli-Robson chart contains multiple rows of capital letters against awhite background. The top left letter is printed in black, with eachsuccessive row and/or letter being printed in a lighter shade of grey,the bottom row and right letter being printed in a shade close to white.The system may project a Pelli-Robson chart or similar sequence ofletters, numbers, shapes, or other patterns of increasing or decreasingcontrast. The wearer may be asked to read the sequence of letter ornumbers or describe shapes or patterns, providing a response via any ofthe response methods described above. The system may then determine acontrast sensitivity of the wearer based on the lowest contrast forwhich the wearer is able to accurately detect the presence of a letter,number, shape, or other pattern.

Similarly, the system may use a sine-wave grating image as a staticimage for contrast sensitivity testing. A sine-wave grating imageincludes a series of fuzzy, parallel bars of lighter and darker shades.The bars may vary in width (i.e., spatial frequency) along the axisperpendicular to the bars. A series of sine-wave gratings of variouscontrast amplitudes (i.e., the difference in light intensity between thedarkest and lightest portions of the image) may be shown to the wearer.The wearer may be direct to indicate whether the bars are visible ineach image, and if so, which bars are visible. Thus, the system may beable to determine the wearer's contrast sensitivity for various spatialfrequencies. In some embodiments, a sine-wave grating test may becombined with glare testing. For example, the device may furthercomprise at least one inward-facing light source directed at the eyes tosimulate glare conditions so as to determine the effect of glare on thecontrast sensitivity of the wearer.

Contrast sensitivity testing may be performed in discrete tests ondemand, or may be performed periodically and/or repeatedly over time.Repeated analysis may allow for the tracking of progressively decreasingor increasing contrast sensitivity through historical analysis ofprevious results, as well as for monitoring or detecting abnormalities.Thus, contrast sensitivity testing functions may be incorporated into adevice worn only for ophthalmic diagnosis, or may be a part of a deviceworn regularly, such as for entertainment, work, or other purpose(s), sothat examinations may be performed automatically at regular intervalsand/or at various times of day, week, month, year, etc. In someembodiments, the frequency of regularly scheduled tests may beautomatically adjusted based on trending of the contrast sensitivitytesting results. If the system detects that the wearer is experiencingdecreased contrast sensitivity, the system may initiate further testingand/or contact a clinician. For example, the system may contact aclinician if it detects that the wearer is having difficulty seeing indark conditions or exhibiting accommodation/vergence fluctuationsassociated with struggling to focus. In augmented or virtual realitysystems, the system may use outward facing camera(s) to provide alertsto a wearer. Alerts may be based on detection of hazardous conditionsnot visible to a wearer due to a deficiency in contrast sensitivity. Thesystem may determine the presence of an invisible hazard based on acorrelation of the images from the outward facing camera(s) with knowncontrast sensitivity data of the wearer, such as light conditions inwhich the wearer has reduced contrast sensitivity. When a hazard isdetected that the wearer is unlikely to be able to see, such as anincoming dark object or a hole in the ground during darkened nighttimeconditions, the system may alert the wearer. Alerts may include visual,audio, or tactile notifications.

The system may further provide therapeutic functionality based ondetected contrast sensitivity deficiency. For example, afterdetecting/diagnosing a reduced contrast sensitivity, the display device62 may simulate contrast-enhancing tinted glasses, such as yellow-tintedglasses. Tinting simulation may be accomplished in augmented realitysystems by color enhancement or other processing, as described elsewhereherein. In virtual reality systems, an outward-facing camera or camerasmay be used to image the world, and a yellow-tint filter may be appliedbefore projecting the image of the world to the wearer through thedisplay device.

Visual Fields

In one or more embodiments, the ophthalmic system may be configured todetect, diagnose and/or compensate for visual field deficiencies. Visualfield testing may be used to detect visual deficiencies in the centraland/or peripheral vision by analyzing a subject's ability to seestationary and/or moving objects and/or images at various locations ofthe subject's visual field. Visual field testing may indicate thepresence of various conditions, such as scotoma, trauma to the cornea,vitreous tears, traumatically induced cataracts, retinal hemorrhage,retinal detachment, macular degeneration, or intrabulbar hemorrhage(Torsion's syndrome).

The ophthalmic system may be configured to administer visual fieldtesting by determining the ability of a subject to detect an image atvarious locations within the visual field. In some embodiments, theophthalmic system may be a user display device 62 such as shown in FIG.5, which includes a projecting subsystem 18 configured to project light38 into the eye of a wearer to form an image in the eye. The userdisplay device 62 includes a display lens 106 which may be mounted to auser's head or eyes by a housing or frame 108. The display lens 106 maycomprise one or more transparent mirrors or reflective featurespositioned by the housing 84 in front of the user's eyes 20 andconfigured to reflect projected light 38 into the eyes 20 (and alsopotentially facilitate beam shaping). These reflective surfaces may bepartially transmissive to also allowing for transmission of at leastsome light from the local environment. FIG. 10D also includes anotherview of an embodiment of a display device comprising a plurality ofdisplays 200, 202, 204, 206, 208 that may be utilized to inject imageinformation into a plurality of respective waveguides 182, 184, 186,188, 190, each of which may be configured, as described above, todistribute incoming light across the length of each waveguide, for exitdown toward the eye. The displays 200, 202, 204, 206, 208 may comprisefiber scanning devices (FSDs) to form the image. Such devices can beconfigured to project a stationary or moving image at a portion of thevisual field, such as at the periphery.

The system can then detect a response from the wearer. For example, theimage may be a small dot that can be clearly seen if projected in ahealthy portion of the visual field but likely would not be seen ifprojected in a deficient portion. In some embodiments, the wearer may beprompted automatically or by another user, such as a medicalprofessional, to indicate if the wearer saw an image and/or the time atwhich the wearer observed the image. The user may then input thewearer's response through a user interface. In some embodiments, theophthalmic system may increase accuracy by using eye tracking cameras 24or similar detection methods to observe if an involuntary reactionoccurs in response to the projection of the image, such as a change infocus or gaze, or a blink. Eye tracking and/or head pose measurement canfurther be used for noise filtering in measured data, as well as toensure that the image is actually projected to the desired part of theretina. Eye tracking cameras 24 may be inward-facing (i.e., directedtoward the user's eye) cameras as illustrated in FIG. 5. In someembodiments, the ophthalmic system may directly prompt the wearer toindicate if the image was observed, such as by a manual input or byconsciously directing the wearer's gaze to the image or to a projectedvirtual button image. In some embodiments, the system may requireverification by the user of a characteristic of the image (e.g., anumber, color, letter, shape, etc.) to ensure that the wearer saw theimage. A virtual button image may be projected by the display lens 106,and the wearer's selection of the button may be detected by the eyetracking cameras 24 or through gesture recognition. Wearer responses mayalso be detected by voice recognition. For example, the system maydetect a wearer's spoken indication of seeing the image, or of one ormore characteristics of the image, as described above.

In some embodiments, the system may be used to evaluate the wearer'svisual field perception at the periphery of the field of view. Forexample, the system may provide a stationary fixation target near theoptical axis. While the wearer's gaze is fixed at the fixation target,an image may be projected at an outer portion of the display, outsidethe wearer's visual field. The image may then be moved inward, towardthe fixation target, until it enters the field of view. The wearer maybe directed to indicate when the target becomes visible, such as by anyof the response methods described above. In some embodiments, the wearermay be directed to describe a characteristic of the image, such as ashape, number of apparent objects, or other feature. The test may berepeated in various quadrants or locations of the periphery of thewearer's visual field, such as at the left, right, top, and/or bottom ofthe visual field. In embodiments where the ophthalmic system comprisesan augmented reality system, a physical object, such as a finger orother suitable object, may be used instead of a projected image, withthe display providing the fixation target.

Visual field testing may be performed in discrete tests on demand, ormay be performed periodically and/or repeatedly over time. Repeatedanalysis may allow for the tracking of progression of visual fielddeficiencies through a historical analysis of previous results. Thus,visual field testing functions may be incorporated into a device wornonly for ophthalmic diagnosis, or may be a part of a device wornregularly, such as for entertainment, work, or other purpose(s), so thatexaminations may be performed automatically at regular intervals and/orat various times of day, week, month, year, etc. In some embodiments,the frequency of regularly scheduled tests may be automatically adjustedbased on trending of the visual field testing results.

In augmented or virtual reality systems, the system may use outwardfacing camera(s) for providing alerts to a wearer. Alerts may be basedon detection of hazardous conditions not visible to a wearer due to avisual field deficiency. The system may determine the presence of aninvisible hazard based on a correlation of the images from the outwardfacing camera(s) with known visual field data of the wearer, such asquadrants in which a wearer has reduced peripheral vision. When a hazardin a deficient quadrant is detected, such as an incoming object, a holein the ground, or other condition, the system may alert the wearer.Alerts may include visual, audio, or tactile notifications.

Laser Photodynamic Therapy

In one or more embodiments, the ophthalmic system may be configured toadminister laser therapy to the eye of the wearer to treat various eyeconditions. For example, the ophthalmic system may include a laser (e.g.laser (27); FIG. 5), and the eye of the wearer may be subjected to laserlight at a selected wavelength and intensity for a particular durationselected to alter eye tissue.

As an example of a condition treatable by the laser therapy, theophthalmic system may be used to prevent or mitigate age-related maculardegeneration (AMD). AMD is a common eye condition that may causesignificant visual loss in affected patients. AMD may affect patients ineither a dry form or a wet form. The dry form generally causes gradualvision loss from deterioration of the retina. The wet form involves thegrowth of abnormal blood vessels under the retina called choroidalneurovascularization (CNV). These abnormal blood vessels can leak fluidand/or blood and may affect visual deterioration.

In some embodiments, the ophthalmic system may comprise one or morecomponents for laser photodynamic therapy to combat AMD and/or othersuch related diseases. Laser therapy has proven to be beneficial intreating AMD. The ophthalmic system may be configured to determine alocation of macular degeneration, and administer laser treatment orlaser photodynamic treatment to the areas most affected by AMD or anyother related disease. In some embodiments, the location of the maculardegeneration may be determined by imaging the eye (e.g. using cameras(24); FIG. 5), which may include imaging the retina and tissuesurrounding the retina, and/or by visual fields testing to determine thepresence and location of choroidal neurovascularization. Once thelocation of the choroidal neurovascularization is determined, laserlight may be selectively applied to that location. The laser may beadministrated such that the growth of abnormal blood vessels ismitigated, and in some cases, the laser may help close or reduce theexcess blood vessels, in addition to removing or destroying other tissueor blood cells, in the case of wet form AMD.

It will be appreciated that abnormal blood vessel growth may occur inwet AMD (e.g. in the choroid behind the retina, due to ChoroidalNeovascularization or CNV). The abnormal blood vessels may leakblood/fluid (including blood cells) onto the central vision area.Advantageously, exposing the abnormal vessels to a laser may causecoagulation at the sites of exposure, thereby reducing the leakage offluid from the vessels, which in turn may help to keep the maculaunobstructed. Causing coagulation using the laser may be referred to aslaser photocoagulation. Without being limited by theory, it is believedthat the light energy provided by the laser may heat tissue and/or fluidin the blood vessels, which may seal and/or destroy the tissue and/orfluid, including the blood vessels.

The laser photocoagulation may take various forms and treat variousconditions. In some embodiments, the photocoagulation treatretinoblastoma. For example, the laser beam may be aimed through thepupil and focused on blood vessels that surround and supply theretinoblastoma tumor, destroying the blood vessels with the heat causedby the beam. As a result, the cancer cells forming the tumor are starvedof nutrients and the tumor may be reduced in size or destroyed.

In some embodiments, the laser photocoagulation may be a focalphotocoagulation in which specific leaking blood vessels in a small areaof the retina, usually near the macula, are identified and sealed. Insome other embodiments, the laser photocoagulation may be a scatter(pan-retinal) photocoagulation. Such a scatter treatment may be used toslow the growth of new abnormal blood vessels that have developed over awider area of the retina. Hundreds of laser burns or exposures may bemade on the retina to stop the blood vessels from growing over thatrelatively wider area.

In one or more embodiments, photodynamic therapy (PDT) may be used toclose abnormal blood vessels caused due to AMD without damaging theoverlying retina. The ophthalmic system may comprise a separate moduleto inject a photo-sensitizing agent (Visudyne) into a vein, or thephoto-sensitizing agent may be separately injected (e.g. by a medicalprofessional). The photo-sensitizing agent may then travel through thebloodstream and collect in the abnormal vessels under the retina.

The ophthalmic system may then be configured to administer a low-energylaser (e.g., through a laser module of the ophthalmic system) toactivate the photo-sensitizer. The activated photo-sensitizer results ina chemical reaction that leads to the closure of the leaking bloodvessels.

In one or more embodiments, the ophthalmic system may comprise one ormore laser modules to selectively administer laser therapy into theuser's eyes. By determining the presence and/or location of the diseaseor application, an area requiring treatment may be determined, atreatment protocol may be determined, and the laser may be activatedsuch that laser therapy is specifically delivered to particular part(s)of the eye.

In some embodiments, the ophthalmic system may be configured to delivervisual and/or auditory information to the wearer as part of a lasertherapy. It will be appreciated that visual information may be displayedon the display (62; FIG. 5) and audible information may be deliveredusing the speakers (66; FIGS. 3A-3D).

For example, the ophthalmic system may be configured to provide visualand/or auditory instructions to the wearer before exposing the wearer tolaser light. In some embodiments, the ophthalmic system is configured todisplay images to the wearer as part of the laser therapy. It may bedesirable in some therapies to orient the eye of the viewer towards aparticular direction to, e.g. facilitate access of a particular part ofthe eye by light from the laser, and/or to keep the eye in a desiredorientation. In such embodiments, the ophthalmic system may beconfigured to orient the eye by displaying an object for the eyes of thewearer to focus on. The object may be maintained at one stable locationto facilitate maintaining the eye of the wearer in a particularorientation. In some other embodiments, the displayed object may move toencourage movement of the eye, so that the eye traces out apredetermined pattern. In some embodiments, the ophthalmic system mayprovide instructions to the wearer after exposure to light from thelaser. For example, the ophthalmic system may display instructionsand/or provide audible instructions for the wearer to take variousactions, e.g. to facilitate recovery after the laser treatment. Asexamples, the instructions may comprise one or more of shutting theeyelids for a set duration and blinking a set number of times.

Delivery of Medication

In one or more embodiments, as discussed herein, the ophthalmic devicemay include an augmented or virtual reality system such as the system 62(FIG. 5) comprising the medication dispending module (21). Themedication dispensing module (21) may be configured to advantageouslydeliver a prescribed medication to the user or wearer of the displaysystem (62). The dispensing of the medication may be conducted based ona prescribed treatment protocol in some cases.

As an example, the ophthalmic system may be configured to dispense aliquid, such as a saline solution, to the wearer. In some embodiments,the liquid solution may be delivered as a mist (e.g., using outlets 22in embodiments where one or more outlets is an atomizer), as a spray, asdrops, and/or as a stream of liquid. It will be appreciated that thesize and shape of the openings in the outlets 22 and/or the speed andpressure of the liquid solution exiting the openings may be selected tooutput a mist, spray, drops, or stream as desired for a particularapplication. In one example, the ophthalmic device may be configured todetect whether the eyes of the wearer are dry and to output the liquidout of the outlets 22 upon detecting that the wearer's eyes are indeeddry. For example, the ophthalmic system may be configured to output amist, and thus a mist may be delivered to patients or wearers sufferingfrom dry eye.

It will be appreciated that the application of a liquid, such as asaline solution, to the eye can aid in the treatment of or alleviate dryeye symptoms associated with various conditions. For example, patientswith rheumatoid arthritis may benefit from such a liquid, as corneal andconjunctival drying may be found in such patients. Without being limitedby theory, lymphocytic infiltration is believed to destroy thetear-forming glands, thereby causing dryness. As a result, patients mayexperience blurred vision and/or a foreign body sensation in or aroundtheir eyes. In addition, severe drying may cause the cornea to becomepermanently scarred. The regular application of a liquid, such as asaline solution, to the eye may help to alleviate or prevent dryness,thereby alleviating the effects of dryness noted above. More generally,as discussed herein, the application of the liquid may be used to treatthe “keratitis sicca” syndrome, which may also found be found in otherconnective tissue diseases, e.g. Sjögren's syndrome and sceroderma.

In some embodiments, the degree of dryness may be detected usingfluorescein dye applied to the eye, e.g., to the cornea. The dye isbelieved to stain and show green colors in de-epithelialized areas, inwhich eye tissue has been damaged by dryness. In some embodiments, theophthalmic system is configured to apply the die to the eye and a cameraon the ophthalmic system may be utilized to detect staining of eyetissue, e.g., to detect green colors in the cornea. The amount of staindetected (e.g., the intensity of the green color) may be correlated withand used to determine the amount of liquid applied to the eye, e.g., theamount of saline solution applied to address eye dryness.

In general, in some embodiments, eye dryness may be detected by imagingthe eye and detecting indicia of dryness, or of the presence of water.Once a detected parameter reaches a threshold, the ophthalmic system maybe configured to apply a liquid to the eye. For example, multispectralimaging and funduscope examinations of the cellular composition andcharacteristics of the eye may be used. In some other embodiments, eyedryness may be detected by using an inward-facing camera to detect theglint of the eye tissue. If it is wet, there will be light reflectedback, if it is dry the reflection will be less. In some embodiments, acamera and an eye color sensor may be utilized to detect redness in theeye or bloodshot eyes. The level of redness in the eye, or bloodshoteyes, may be interpreted by the ophthalmic system as dryness. In someother embodiments, the degree of blinking may be used to determine thatthe user's eyes are dry. For example, a rate or frequency of blinkingabove a threshold may be indicative of dryness or other eye irritation,it may trigger the application of a liquid to the eye. In someembodiments, multiple tests or indicators of dryness may be detected inconjunction with one another to increase the accuracy of a drynessdetermination.

As disclosed herein, it will be appreciated that the delivery of themedication may be triggered by one or more conditions detected in theenvironment or the wearer. In some embodiments, the ophthalmic systemmay include one or more sensors to measure one or more of a temperatureof the wearer and/or environment, a duration since an immediatelyprevious delivery of liquid to the eye, an ambient humidity, and apollen or particulate count. The ophthalmic system may also beprogrammed with thresholds for various measurements. The ophthalmicsystem may be further programmed to deliver an appropriate liquid to theeye of the wearer once a particular threshold is exceeded. For example,the presence of foreign objects (e.g., as determined by a pollen orparticulate count, or a camera inspection of the eye to detect a foreignobject on the eye) over a particular threshold may be considered an eyeirritant and a saline or water stream may be applied to the eye to flushthe irritants. In some cases, a database, such as a remote database, ora calendar may be consulted to validate or determine the likelihood ofthe presence of foreign objects. For example, it will be appreciatedthat pollen from different types of plants may be present at differenttimes of the year and a known sensitivity of the user to a particulartype of pollen may cause the threshold for the application of medicationto the eye to be lowered at a time of year when that particular type ofpollen is known to be present. At other times of the year, the thresholdmay be raised by the ophthalmic system. In some embodiments, thepresence of other irritants, such as chemicals or liquids, e.g.,chlorine, may be detected or inferred. For example, the user may bedetermined, by imaging his/her surroundings and/or detecting a locationof user, to be in a chlorinated pool. Upon exiting the pool, theophthalmic system may be configured to flush the eye to removechlorinated water. In another example, a treatment protocol may specifythe delivery of the liquid a given number of times over a time periodand the ophthalmic system may be configured to deliver the liquid atregular time intervals within that time period.

In some embodiments, the liquid may be delivered in conjunction withother types of therapy. For example, phototherapy or laser therapy maybenefit from the application of photosensitive liquids, e.g.,photosensitive dyes, to the wearer. In some embodiments,ultraviolet-activated riboflavin treatment for myopia may be conductedusing Vitamin B2 (riboflavin) which is applied onto the cornea and thenultraviolet A (UVA) light is directed to the eye (e.g., from theophthalmic system or an external source) for a set duration (e.g., 20minutes) to strengthen, stiffen and flatten a distorted cornea. Thephotosensitive liquids may react with the applied light to improvecontrast and/or the ability to image features in the eye. For example, adye may selectively accumulate on or in particular material orstructure, e.g., blood vessels, thereby improving the ability of imagingdevices (e.g., cameras 24) to image those blood vessels in the eye. Asanother example, eye diagnostics may benefit from application of a pupildilating liquid to the eye. The dilation may be utilized to provide abetter view into the interior of the eye.

Platform for Other Therapies

Advantageously, the proximity of the ophthalmic system to the userallows the ophthalmic system to dispense other types of therapy to theuser based on a treatment protocol. Examples of these other types oftherapy may include vibration at specific times (e.g., massage the faceor skull), sound (e.g., binaural beats, etc.), temperature (e.g.,cooling, warming means), to name a few.

To facilitate these other therapies, with reference again to FIG. 5, insome embodiments, the display device may comprise an actuator (30)connected to a terminal part (30 a) that is configured to contact thewearer, to administer vibration therapy to the wearer. As illustrated,the actuator (30) may be mounted on the frame (108) and the terminalpart (30 a) may be positioned to contact the face or skull of thewearer. The actuator (30) may be configured to move the terminal part(30 a) back-and-forth to provide vibration to the wearer. e.g., byapplying and removing pressure at the point of contact with the wearer.While a single actuator (30) is illustrated, it will be appreciated thatthe ophthalmic system may include multiple actuators (30), mounted onthe frame (108), and/or otherwise attached to the wearer and inelectronic communication with the ophthalmic system.

Examples of suitable actuators include piezoelectric actuators, whichmay advantageously be made small and can generate vibrations in a widerange of frequencies or intervals. Other examples of actuators includeeccentric cams, Eccentric Rotating Mass (ERM) vibration motors (such aspager motors), and Linear Resonant Actuators (LNAs). In someembodiments, these actuators may be used to cause vibration of the frame(108), thereby distributing the vibration over the multiple points ofcontact that the frame (108) makes with the wearer, rather than just ata single point of contact with the actuator. In some embodiments, theactuator (30) may also be configured to move along two or more axes to,e.g., provide a brushing or kneading motion at the point of contact withthe wearer.

In some embodiments, one or more actuators (30; FIG. 5) may providetactile or vibration therapy to the wearer. For example, the actuator(30) may move to provide vibrations at the point of contact with thewearer, and/or may vibrate the frame (108) to provide vibrations to thewearer through the frame (108). As another example, as noted above, theactuator (30) may be configured to brush or move along the surface ofthe wearer's face or skull. In some embodiments, the ophthalmic systemmay be configured to have the actuator (30) apply pressure at aparticular location for an extended duration to, e.g., provide anacupressure treatment. In some embodiments, the actuator (30) may beconfigured to vibrate at ultrasonic frequencies to emit ultrasonic soundwhich provide a non-contact haptic ultrasound treatment.

In some embodiments, the ophthalmic system may be configured to providetemperature therapy to the wearer. With continued reference to FIG. 5,the display device may include a temperature regulator (29) incommunication with a heating/cooling outlet (28) via the connector (28a). In some embodiments, the temperature regulator (29) may includeresistive heating filaments and/or a cooler with cooling coilscontaining a refrigerant. In some other embodiments, the temperatureregulator (29) may be a thermoelectric heater or cooler that makes useof the thermoelectric effect to achieve the desired degree of heating orcooling. The temperature regulator (29) may also include a gas source(e.g., pressurized air), which delivers the gas to the heating/coolingoutlet (28) via the connector (28 a). In such arrangements, theconnector (28 a) may be a channel or tube, and the heating/coolingoutlet (28) may be an opening through which the gas exits and isdirected to the wearer, e.g., to one or more eyes of the wearer. Thetemperature regulator (29) heats or cools the gas as desired, e.g, for aparticular therapy, before the gas is directed to the viewer.

In some embodiments, the connector (28 a) may be a thermal pipe whichprovides and/or removes heat from the frame (108) and theheating/cooling outlet (28) may simply be the point of contact betweenthe connector (28 a) and the temperature regulator (29). In sucharrangements, one or more thermal pipes may also be arranged along theframe (108). Such an arrangement may be utilized to regulate thetemperature of the frame (108), which may also allow therapies based ontemperature to be applied around the eyes of the wearer. In someembodiments, the temperature regulator (29) may be integrated into theframe (108).

In some embodiments, the ophthalmic system may be configured to conducta temperature therapy using the heater and/or cooler (29; FIG. 5). Forexample, as discussed herein, heated and/or cooled streams of air (e.g.,through the heating/cooling outlet (28)) may be applied to the wearer,e.g. to one or more eyes of the wearer. As another temperature therapy,the frame (108) may be heated and/or cooled to subject the eyes of theviewer and the neighboring areas to different temperatures as part of atherapy protocol. In one or more embodiments, the ophthalmic device mayalso comprise EEG sensors (31; FIG. 5) to map brain activity. The EEGsensors (31) may detect any abnormal activity or pattern in the brainand report out to the user and/or clinician. This may be especiallyuseful for patients immediately after brain surgery or for at-riskpatients. The ophthalmic device may be pre-programmed with an EEGsensing module to analyze data collected by the EEG sensors (31). Whilea single EEG (31) sensor is illustrated, it will be appreciated that theophthalmic device may include multiple EEG sensors contacting the wearerat multiple locations.

In other embodiments, the ophthalmic system may be configured todispense other types of medication or therapies based on a treatmentprotocol. Advantageously, the proximity of the ophthalmic system to thewearer allows various other types of therapy to be readily administeredto the wearer, including therapies based on, for example, directphysical contact with the wearer, sound, and/or temperature. These othertypes of therapy may include tactile stimulation, including vibration atspecific times (e.g., massage the face or skull), sound (e.g., binauralbeats, etc.), temperature (e.g., cooling, warming means), to name a few.

In some embodiments, the ophthalmic system may be configured toadminister sound therapy to the user using a speaker, such as thespeaker (66; FIGS. 3A-3D). For example, the ophthalmic system may beconfigured to deliver binaural beats to the ears of the wearer throughthe speaker (66). A pair of the speakers (66) may be provided, one foreach ear of the wearer. As another example of sound therapy, theophthalmic system may be configured to direct sound waves to the eye ofthe wearer. For example, in some embodiments, the ophthalmic system mayinclude one or more speakers, or sound transducers, (67; FIG. 5). Thespeakers (67) may be attached to the frame (108) may be directed towardsthe eye of the wearer to provide sound stimulation to the eye.

It will be appreciated that these therapies may be applied based ondeterminations of the wearer's physical and/or mental state. Forexample, the ophthalmic system may include the EEG sensor (31), whichmay be utilized to detect the presence of triggers for launching one ofthese other therapies. In some embodiments, the EEG sensor (31) may beutilized to detect electrical activity in the brain that is indicativeof stress. Upon detecting such activity, the ophthalmic system may beconfigured to apply massage therapy to the wearer with the goal ofreducing stress levels.

In some embodiments, the ophthalmic system may be configured to deliveralerts to the wearer (e.g., a patient) as part of the delivery ofmedication to the wearer or as part of other therapies. It will beappreciated that the alert may be visual or based on other action whichmay be sensed by the wearer, including sound-based alerts,pressure-based alerts, and/or temperature-based alerts. For example, thealerts may take the form of audio notifications, tapping/pressure on theuser by the ophthalmic system, applying heat or removing heat, ordirecting airstream to the wearer. In one or more embodiments, thepatient may receive an alert directing them to keep their eyes open,and/or focus on a visual cue while the medication or any of the abovetherapies is delivered. In some embodiments, keeping their eye open maybe facilitated by displaying an object or image(s) for the wearer tofixate on. In some other embodiments, the alert may instruct orotherwise encourage the wearer to focus on a displayed visual cue. Thevisual cue may move, and the tracking of that moving cue by the wearer'seyes may be utilized to provide different orientations and/or views ofthose eyes. It will be appreciated that the display system may setvisual alerts at any desired depth plane, thereby allowing the alerts tobe clearly seen and/or read without the wearer needing to changeaccommodation and/or vergence.

As disclosed herein, the ophthalmic device may be an augmented realityhead-mounted ophthalmic system or a virtual reality head-mountedophthalmic system. It will be appreciated that the augmented realityhead-mounted ophthalmic system may be configured to pass light from theworld into the eye of the wearer wearing the head-mounted ophthalmicsystem. On the other hand, the virtual reality head-mounted ophthalmicsystem may be configured to not pass light from the world in front ofthe head-mounted ophthalmic system into the eye of the wearer wearingthe head-mounted ophthalmic system. In such virtual reality systems,light from the outside world would not form an image of the world in theeye of the wearer. Rather, in some embodiments, images of the world seenby a wearer wearing the system are limited to those displayed by thedisplay in the ophthalmic system.

Referring now to FIG. 25, an exemplary embodiment 2500 of the ophthalmicsystem is briefly described. It should be appreciated that otherembodiments of the ophthalmic system may comprise additional components(e.g., light emitting module, ultrasound module, imaging module,electrodes, etc.) FIG. 25 illustrates a basic structure for theophthalmic system, but it should be appreciated that other componentsmay be used in conjunction with the ophthalmic system for differentapplications. The ophthalmic system generally includes an imagegenerating processor 812, at least one FSD (or any other spatial lightmodulator) 808, display or image processing circuitry 810, a couplingoptic 832, and at least one optics assembly that 802. The system mayalso include an eye-tracking subsystem 808.

As shown in FIG. 25, the display circuitry may comprise circuitry 810that is in communication with the image generation processor 812, amaxim chip 818, a temperature sensor 820, a piezo-electricaldrive/transducer 822, a red laser 826, a blue laser 828, and a greenlaser 830 and a fiber combiner that combines all three lasers 826, 828and 830.

The image generating processor is responsible for generating images tobe ultimately displayed to the user. The image generating processor mayconvert an image or video associated with treatment or diagnosticcontent to a format that can be projected to the user in 3D. Forexample, in generating 3D content, the virtual content or images mayneed to be formatted such that portions of a particular image aredisplayed on a particular depth plane while other are displayed at otherdepth planes. Or, all of the image may be generated at a particulardepth plane. Or, the image generating processor may be programmed tofeed slightly different images to right and left eye such that whenviewed together, the image appears coherent and comfortable to theuser's eyes.

In one or more embodiments, the image generating processor 812 deliversimages and/or light to the optics assembly in a time-sequential manner.A first portion of a virtual scene may be delivered first, such that theoptics assembly projects the first portion at a first depth plane. Then,the image generating processor 812 may deliver another portion of thesame scene such that the optics assembly projects the second portion ata second depth plane and so on.

The image generating processor 812 may further include a memory 814, aCPU 818, a GPU 816, and other circuitry for image generation andprocessing. The image generating processor may be programmed with thedesired virtual content to be presented to the user of the ophthalmicsystem. It should be appreciated that in some embodiments, the imagegenerating processor may be housed in the wearable ophthalmic system. Inother embodiments, the image generating processor and other circuitrymay be housed in a belt pack that is coupled to the wearable optics.

The ophthalmic system also includes coupling optics 832 to direct thelight from the light modulator (e.g., FSD) to the optics assembly 802.The coupling optics 832 may refer to one more conventional lenses thatare used to direct the light into the DOE assembly. The ophthalmicsystem also includes the eye-tracking subsystem 806 that is configuredto track the user's eyes and determine the user's focus.

In one or more embodiments, software blurring may be used to induceblurring as part of a virtual scene. A blurring module may be part ofthe processing circuitry in one or more embodiments. The blurring modulemay blur portions of one or more frames of image data being fed into theDOE. In such an embodiment, the blurring module may blur out parts ofthe frame that are not meant to be rendered at a particular depth frameor blurring may be used to diminish the transitions between depthplanes.

Outward Looking Camera

As described herein, in some embodiments, the system may include one ormore outward-looking (e.g. forward-looking) cameras to capture imageinformation from the ambient environment, and this image information maysubsequently be displayed as images presented to the wearer of system.In some embodiments, the images presented by the system to the wearermay be re-rendered to provide images that are modified relative toimages originally captured by the camera. The modification may beperformed by a processor, e.g., an image processor, that receives theimage information captured by the cameras and processes the imageinformation to include changes that are later communicated to lightmodulators that generate the displayed image. In some embodiments, thewearer's view of the world and particular features in that view may bemodified as desired for diagnostic or therapeutic purposes.

With reference to FIG. 5, the head-mounted health system may include oneor more outward-facing cameras 16 (e.g., two outward-facing cameras) toimage the world around the wearer. The system may process the imageinformation (e.g., image(s)) captured by the camera(s) 16 to re-renderthe image information for display to the wearer. In some embodiments,the device may project light from the display device 108 to the wearer'seye so as to project a re-rendered image of the world to wearer.

In some embodiments, in the re-rendering step, the processor may beconfigured to selectively modify properties of the image that will bedisplayed to the wearer. For example, the processor may be configured toselectively alter portions of the image based on a distribution ofhealth and unhealthy cells in a retina of the wearer, e.g., so thatthose portions are projected to healthy retinal cells, while portions ofthe image projected to unhealthy retinal cells may be reduced,minimized, magnified, brightened, or otherwise altered in magnification,intensity, hue, saturation, spatial frequency, or other quality.Similarly, any desired portion of the image may be modified inmagnification, intensity, hue, saturation, spatial frequency, or anyother quality as required to mitigate and/or compensate for any knownophthalmic condition of the wearer. The wavefront of the image may alsobe modified and/or reshaped so as to mitigate focus-related conditionsin some embodiments. In other examples, the system may also be used togenerally darken bright rooms and/or brighten nighttime views forwearers with difficulty adjusting to changing light conditions, by,e.g., substituting all or portions of the user's view of the world withre-rendered content, which may present a darker or lighter view of theworld, as desired. In another example, the system may modify or shiftcolors to enhance the vision of the wearer, including colorblindwearers. It will be appreciated that the system may include an augmentedreality display or a virtual reality display, and that re-renderingimage information as disclosed herein may be applied in displayingcontent on either type of display.

Continuing with FIG. 5, in some embodiments, the health system may haveone or more forward and outward looking cameras 16 that image the worldaround (e.g., in front of) the wearer. The system may be configured todetermine various characteristics of the image, such as the intensity,hue, saturation, and/or spatial frequency of regions of the image. Thesystem may process, re-render, and reproduce to the wearer, via thedisplay device 108, an image of the world based on the informationcaptured by the outward-facing cameras 16, with some modifications ofbrightness, magnification, color, wavefront, and/or other parameters asdescribed above. In some embodiments, the display device may projectonly a partial image to the eye of the wearer, with the partial imageaugmenting the light passing through the display to the eye of thewearer to produce the desired modification. For example, the augmentedreality system may shift the color of portions of the image based on aknown color detection deficiency of the wearer, as described elsewhereherein. In another example, the augmented reality system may enhance thedifference in brightness between two or more portions of the image basedon a known contrast sensitivity deficiency of the wearer.

In some embodiments, the display may be a light field display, such asdescribed herein.

Example Systems with Transmissive and Reflective Adaptive Optics

In one or more embodiments, the ophthalmic system may be configured toinclude reflective adaptive optics to provide correction for conditionssuch as spherical aberrations, astigmatism, and/or higher orderaberrations. Some aberrations, such as myopia, hyperopia, andastigmatism, and/or higher order aberrations, may be corrected by asystem comprising a transmissive adaptive optics element, such as thesystem 2900 depicted in FIG. 29A. Treatment of myopia, hyperopia, andastigmatism, and/or higher order aberrations with transmissive adaptiveoptics is discussed in greater detail elsewhere herein. The system 2900of FIG. 29A may be incorporated in any of the wearable augmented orvirtual reality devices described elsewhere herein.

In an augmented reality device, the system 2900 may include an adaptiveoptics element such as a transmissive variable focus element 2902 (VFE)located at a pupil conjugate plane 2904 and configured to modify theincoming light approaching the pupil 2906 of the eye to correct foraberrations. In some embodiments, light from the world may betransmitted from the world through the transmissive VFE 2902 to thepupil 2906 of an eye 2908 of the wearer by a series of lenses 2910,2912, 2914, 2916. The light from the world may enter as a wavefront ofcollimated light, and each pair of lenses 2910/2912, 2914/2916 may forman afocal telescope, wherein the input and output of the telescope cancomprise collimated light. As shown, the transmissive VFE is between thetwo afocal telescopes. In some embodiments, the system comprises arelay, and the system can be configured to be telecentric. A fiberscanning display 2918 may project additional light to form augmentedreality images in the eye 2908. To combine the output beam 2920 of thefiber scanning display 2918 with the light entering the system 2900 fromthe world, light from the fiber scanning display 2918 may be projectedto a beam splitter 2922 such that the corrective VFE 2902 is disposedbetween the beam splitter 2922 and the eye 2908. Thus, both light fromthe world and light from a fiber scanning display 2918 may be directedto the eye of the wearer, with the images from both light sources beingpotentially corrected for the wearer's aberrations such as myopia,hyperopia, and/or astigmatism by the transmissive VFE 2902 or otheradaptive optic element.

A system such as the reflective system 2901 depicted in FIG. 29B may beable to provide similar correction for wearers with myopia, hyperopia,and astigmatism, and/or higher order aberrations. Rather than atransmissive VFE 2902 as shown in FIG. 29A, embodiments of a reflectivesystem may include a reflective VFE 2926 (e.g., a movable membranemirror or other deformable mirror). The treatment of myopia, hyperopia,and astigmatism, and/or higher order aberrations with reflectiveadaptive optics is discussed in greater detail elsewhere herein.

A system incorporating a reflective VFE 2926 (e.g., a movable membranemirror or other deformable mirror) may comprise many of the sameelements as in the system 2900 of FIG. 29A, such as lenses 2910, 2912,2914, and 2916 which may comprise afocal telescopes. The output beam2920 of a fiber scanning display 2918 may be combined with light fromthe world at a beam splitter 2922 located at an image conjugate plane2924. In some embodiments, the system comprises a relay and can beconfigured to be telecentric. A second beam splitter 2928 may beincluded as shown in FIG. 29B. Light from the world may enter beamsplitter 2928, where at least a portion is reflected to the reflectiveVFE 2926, located at a pupil conjugate plane 2904. The reflective VFE2926 may comprise, for example, a MEMS device or a deformable mirror,for example, such as described herein. The corrected wavefront may thenbe reflected through lenses 2914, 2916 to enter the eye 2908 of thewearer at the pupil 2906. The correction applied to the wavefront at thereflective VFE 2926 may cause the wavefront to form a normal image ofthe light from the world and the light from the fiber scanning display2918 despite the presence of a higher order aberration, as describedelsewhere herein.

Variations of these designs are also possible.

CONCLUSION

As discussed herein, the disclosed head-mounted displays mayadvantageously form part of a user-wearable diagnostic or health system,which may be used for performing health-related diagnostics, monitoring,and therapeutics on the user. In some embodiments, the health-relateddiagnostics, monitoring, and therapeutics may include ophthalmicdiagnostic analyses, monitoring, and therapies. In view of thedisclosure herein, however, it will be appreciated that the diagnosticor health system is not limited to ophthalmic applications and may beapplied generally to health-related diagnostics, monitoring, andtherapeutics.

As discussed herein, a user-wearable diagnostic system is provided. Theuser-wearable diagnostic system may comprise a frame configured to mounton the user and an augmented reality display attached to the frame andconfigured to direct images to an eye of the user. A light detector maybe attached to the frame and configured to detect light reflected froman eye of the user. The user-wearable diagnostic system also comprises aprocessor configured to conduct a health analysis of the user based onlight detected by the light detector or other detectable parameters.Various details of the above-noted features have been described above,and some of the description is reprised in turn below, as an aid to thereader.

In some embodiments, the frame may correspond to the frame (64) (FIGS.3A-3D), and the augmented reality display may correspond to the display(62) (FIGS. 3A-3D). The augmented reality display may comprise awaveguide configured to allow a view of the world through the waveguideand to form images by directing light out of the waveguide and into aneye of the user. The waveguide may be part of a stack of waveguides, andeach waveguide of the stack may be configured to output light withdifferent amounts of divergence in comparison to one or more otherwaveguides of the stack of waveguides. In some embodiments, thewaveguides and waveguide stack may correspond to the waveguides (182,184, 186, 188, 190) and stacked waveguide assembly (178), respectively,of FIGS. 10D-10E, 27, and 28A-28G.

It will be appreciated that the display may be configured to both outputlight to or image information from the user, and to block light from theoutside world. In some embodiments, the diagnostic system may beconfigured to conduct the health analysis by occluding certain areas ofa field of vision of the user.

In some embodiments, the processor may correspond to the localprocessing and data module (70) or the remote processing module (72)(FIGS. 3A-3D). It will be appreciated that the processor may beconfigured or programmed to conduct any of the health analyses disclosedherein.

In some embodiments, the light detector may be an inwardly-facing(user-facing) image capture device, such as an inwardly-facing camera.The camera may be an infrared camera in some cases. The camera maycorrespond to the camera (24) of FIG. 5 in some embodiments. Otherexamples of light detectors include the photodetectors (2352) of FIGS.23A and 23B.

The processor may be configured to conduct a health analysis using dataprovided by the light detector, the data being derived from detectinglight reflected from one or both eyes of the user. For example, thelight detector may be configured to track the movement of the eyes ofthe user. In some embodiments, the user-wearable diagnostic system maycomprise a light source configured to emit light towards the user, andthe light detector may be configured to detect all or portions of theemitted light reflected by the user. The light source may be configuredto emit light of multiple wavelengths, and the diagnostic system may beconfigured to change the emitted wavelength based on the features of theuser to be imaged. In some applications, the light source may beconfigured to emit infrared light or non-visible light, which may haveadvantages in allowing imaging of the eye or surrounding tissue withoutbeing seen by the user. The light source may correspond to the lightsources (26) of FIG. 5 and/or the light source 2354 of FIGS. 23A and 23Bin some embodiments. It will be appreciated that the light source mayinclude a plurality of discrete light emitters that are configured to,e.g., emit light of different wavelengths than other light emitters, andlight of different wavelengths may be emitted by selectively poweringthe light emitters.

In some embodiments, the augmented reality display is a fiber scanningdisplay comprising fibers configured to project light in a pattern toform images in the eye of the user. In some applications, at least somefibers of the fiber scanning display may be used as part of the lightdetector to receive or capture light to image the eye of the user.Advantageously, light propagation in the fibers may occur in multipledirections and the same fibers of the fiber scanning display may beconfigured to project light to the eye (e.g., from a spatial lightmodulator or directly from a light source), and to also receivereflected portions of the light during the health analysis and to directthe light to, e.g., an image sensor. In some embodiments, the fiberscanning display may be configured to change a wavelength of lightprojected into the eye, e.g., by selectively powering a light emitterthat projects light into a scanning fiber which propagates the light tobe projected into the eye. Such changes in wavelength and the subsequentreflection and detection of light of those wavelengths mayadvantageously be used to provide depth information for tissue that thelight is reflected from. In some embodiments, the fiber scanning displaymay correspond to a display utilizing the fibers (352, 362) of FIGS. 28Aand 28B.

The processor may be configured to conduct various health analyses basedon the receipt of light by the light detector. For example, the lightdetector may be configured to monitor an eyelid of the user, and theprocessor may be configured to conduct the health analysis based on thiseyelid monitoring. As another example, the light detector may beconfigured to monitor a pupil of the user, and the processor may beconfigured to conduct a health analysis based on this pupil monitoring.

In some embodiments, the light detector may be configured to image afundus of the eye of the user. In some health analyses, the lightdetector may be configured to image microcirculation in the fundus. Asnoted herein, microcirculation abnormalities may be indicative ofvarious health concerns, which may be detected using information derivedfrom the microcirculation imaging. For example, the processor may beconfigured to analyze brain health and heart health based on informationfrom this microcirculation imaging. In another example, the processormay be configured to detect hypertension based on the imagedmicrocirculation.

In some embodiments, the processor may be configured to conduct thehealth analysis by detecting, using information captured by the lightdetector, one or more of: eye movements, eye movement patterns, blinkingpatterns, eye vergence, fatigue, changes in eye color, depth of focus ofthe eye, changes in focal distance for the eye, eye fatigue, dry eye,and hypertension. In some embodiments, pattern recognition may beapplied to information received from the light detector as part of thehealth analysis.

In some embodiments, the processor may be configured to conduct thehealth analysis by detecting an intraocular pressure of the eye. Thismay be accomplished, for example, by projecting light into the eye andusing the light detector to detect the pattern, density, or amount ofbackscattered light received from the eye.

As discussed herein, the user-wearable health or diagnostic system mayprovide light to the user's eyes through, e.g., the display (e.g.,display (62) (FIGS. 3A-3D)) or another light source (e.g., lightemitting module (27) (FIG. 5)). In some embodiments, the processor maybe configured to conduct a health analysis by directing the augmentedreality display to provide light stimulation to the eye of the user.

As discussed herein, the display may advantageously be configured todisplay images on different depth planes and/or at different locationswithin the user's field of view, which allows the display to cause theeyes to focus and converge at a given depth plane and/or in a givendirection. In some health analyses, this ability to cause the eyes tofocus and converge on different depth planes as desired may be utilizedfor diagnostic purposes. One or more images may be displayed at varyingdepths and images of one or both of the eyes focused at these varyingdepths may be captured for the health analysis. In addition oralternatively, an image may be displayed to cause the eyes to focus andconverge in a particular direction and/or depth plane. This may beutilized, for example, to obtain a desired view of the eye withoutmoving the light detector.

In some embodiments, the light detector may comprise a plurality ofphotodetectors and the photodetectors may be arranged at differentangles to the user. Such a configuration may be used to capturedifferent views of the eye, e.g., different simultaneous views, for ahealth analysis. Examples of such photodetectors include thephotodetectors (2352) of FIGS. 23A and 23B.

It will be appreciated that noise and/or visual artifacts may be presentin the images captured by the light detector. The diagnostic system maybe configured to track eye movements and reduce noise in these imagesbased on the tracked eye movement and/or other body motion such as headmovements. For example, movement of the eye may provide different viewsof the eye, which may be used to determine whether an observed featureis an optical artifact present only in a particular view, or whether theobserved feature is indeed present in the eye (and, thus, present in amultiplicity of different image views). It will be appreciated that headmovements may be tracked using an accelerometer attached to thehead-mounted display system.

As used herein, it will be appreciated that imaging and light detectionmay occur in visible and non-visible wavelengths. Examples of light ofnon-visible wavelengths include infrared light.

It will be appreciated that various other sensors may be provided withthe user-wearable health or diagnostic system to conduct non-eyediagnostics of the user. An example of such other sensors comprises anEEG sensor. The processor may be configured to utilize data obtainedfrom the EEG sensor to conduct the health analysis by detecting brainactivity. In some embodiments, the system is configured to issue analert triggered by the detection of brain activity. The alert may beissued to one or both of the user and a clinician.

In some other embodiments, the other sensors may comprise one or moresensors selected from the group consisting of temperature sensors,pressure sensors, light sensors, non-invasive blood glucose sensors, andETCO2 sensors.

The other sensors may also comprise one or more sensors configured tomonitor one of more conditions of the ambient environment of the user,and the system may be configured to conduct the health analysis usingdata collected by the one or more sensors. For example, the one or moresensors may comprise a camera configured to image the ambientenvironment. The processor may be configured to use information from thecamera to identify and analyze food, drug, nutrients and toxins that theuser intakes. In some embodiments, the processor may be configured tocorrelate identified food, drug, nutrients or toxins with other userhealth data. In some embodiments, the processor may be configured todetermine a head pose of the user based on information received from thecamera. The camera may correspond to a camera (16) of FIG. 5 in someembodiments.

In some embodiments, the other sensors may comprise one or more oflocation and orientation sensors. Examples of location and orientationsensors comprise an accelerometer, a GPS sensor, a compass, a gyroscope,an inertial measurement device, and a camera. In some applications, theprocessor may be configured to conduct the health analysis bydetermining environmental information based upon a location of the user.The processor may be configured to conduct the health analysis byaccessing information characterizing the location. Examples ofinformation characterizing the location comprise one or more of pollencount, demographics, air pollution, environmental toxins, informationfrom smart thermostats lifestyle statistics, or proximity to ahealth-care provider. In some embodiments, the processor may beconfigured to access cloud-based databases to obtain informationcharacterizing the location. The information characterizing the locationmay be combined by the processor with information obtained from one ormore sensors of the diagnostic system to arrive at a result for thehealth analysis.

In some embodiments, the other sensors may comprise a microphone, whichmay be used to gather information about the ambient environment and/orinformation about the user's activities. For example, the microphone maycapture sounds indicative of chewing by the user and the processor maybe configured to determine that the user is indeed chewing food. It willbe appreciated that eating of food may be associated with variouschanges in physiological state and, as such, the timing of food intakemay be a useful variable to take into account when diagnosing variousthe health conditions disclosed herein. The microphone may correspond tothe microphone (55) of FIGS. 3A-3D in some embodiments.

The diagnostic system may also include one or more output devices forproviding non-optical stimulation to the user. An example of such anoutput device comprises a speaker, through which the processor may beconfigured to conduct the health analysis by providing auditorystimulation to the user. As another example, the one or more outputdevices may comprise a heater and/or a cooler. The speaker maycorrespond to the speaker (66) of FIGS. 3A-3D in some embodiments andthe heater and/or cooler may correspond to the temperature regulator(29) of FIG. 5.

It will be appreciated that the processor is programmable andadvantageously allows wide latitude in how the health analyses areconducted. For example, the processor may be configured to perform thehealth analysis autonomously, without requiring user or clinician input.The health analyses may simply be conducted in the background as theuser goes about his/her day in some cases. For example, the diagnosticsystem may detect a condition (e.g., a mental state and/or aphysiological state) which triggers a health analysis. The system maythen conduct the health analysis and may provide results of thatanalysis to the user and/or a clinician. Advantageously, this automaticdetection, analysis, and routing of results may provide a biofeedbackloop to help address health conditions in real-time, or with littledelay. In some other cases, some input from a clinician or a user may beuseful to guide the health analysis and the health analysis may thus beperformed semi-autonomously. In yet other cases, the diagnostic systemperforms the health analysis under the control of the clinician. Suchcontrol may be advantageous, for example, where the analysis requires aclinician to make a judgment or obtain other data regarding the userthat is independent of the parameters that the user-wearable diagnosticsystem is able to measure. It will be appreciated that, whether thediagnostic system is configured to perform the health analysisautonomously, semi-autonomously, or under the control of a clinician,the system may be configured to provide results of the health analysisto a clinician. The clinician may then review the results, advise theuser of additional diagnostics, develop a therapy protocol, etc.

In addition to conducting a one-time health analysis based on currenthealth data, the diagnostic system may be configured to track healthdata over time. The diagnostic system may be configured to performhealth analysis based on this tracked health data. In some embodiments,the diagnostic system may be configured to compare contemporaneoushealth data with historical health data. The diagnostic system may beconfigured to send alerts to the user and/or a clinician in response tocomparing the contemporaneous health data with the historical healthdata. In some embodiments, the diagnostic system may be configured tosend alerts indicating the commencement of a health analysis.

In some embodiments, the diagnostic system may be configured to compareuser health data with data from other users or individuals in thepopulation. For example, the diagnostic system may be configured tocompare health data for the user with standard data for individuals of aparticular age group.

In some embodiments, as disclosed herein, the diagnostic system maycomprise a sound emitter configured to emit sound waves toward the user,and a sound detector attached to the frame and configured to detectsound waves reflected from the user. The light detector, however, may beomitted in some embodiments, or may be retained in other embodiments.The processor may be configured to conduct a health analysis of the userbased on information detected by the sound detector alone or inconjunction with other sensors, such as the light sensor. In someembodiments, the sound emitter may be configured to provide ultrasonicstimulation to the eye of the user. In some embodiments, the soundemitter may be configured to emit ultrasonic sound waves, and the sounddetector may be configured to detect ultrasonic sound waves reflectedfrom the user.

As disclosed herein, the user-wearable system may be a user-wearablehealth system for conducting a health therapy protocol on the user, inaddition to or as an alternative to, health analyses. The user-wearablehealth system may comprise a frame configured to mount on the user; anaugmented reality display attached to the frame and configured to directimages to an eye of the user; and a processor configured to direct theaugmented reality display to conduct a health therapy protocol on theuser. It will be appreciated that the processor may be configured orprogrammed to conduct any of the health therapy protocols disclosedherein.

As noted above, the frame may correspond to the frame (64) (FIGS.3A-3D), and the augmented reality display may correspond to the display(62) (FIGS. 3A-3D). As also noted above, the augmented reality displaymay comprise a stack of waveguides that are configured to provide a viewof the world and to direct image information to the eye of the user.Also, the processor may correspond to the local processing and datamodule (70) or the remote processing module (72) (FIGS. 3A-3D).

In some embodiments, the health therapy protocol comprises providinghealth therapy image information to the user through the augmentedreality display. For example, the health therapy image information maycomprise health alerts. In providing these health alerts, in some cases,the user-wearable health system may comprise a sensor configured tomonitor physiological responses of the user. The processor may receiveinformation from the sensor regarding these physiological responses andmay be configured to select the health alerts based on the informationreceived from the sensor, which may be any of the sensors noted herein.

It will be appreciated that the augmented reality display may beconfigured to display information over multiple depth planes and, assuch, the eye of the user may be focused on one of these depth planes.As a result, the user may not readily see an alert that is on a depthplane that is different from the plane that the user's eyes are focusedon. To provide alerts that are more readily noticed by the user andwhich do not require that the user refocus their eyes to different depthplane, in some embodiments, the health system may comprise an imagesensor configured to detect a depth of focus of the user's eyes. Inaddition, the system may be configured to display the health alert on adepth plane corresponding to that depth of focus.

In some cases, the ability of the augmented reality display to projectan image at a variable focal plane and/or from different directions inthe user's field of view may be utilized as part of the health therapyprotocol. In some embodiments, as discussed herein, the augmentedreality display may be configured to project an image to the eye tofocus the eye in a variable direction or focal plane while the healththerapy protocol is conducted.

It will be appreciated that the augmented reality display may haveoptical power and may be able to modify the path of light incident onthe user's eyes. In some embodiments, the health therapy conducted bythe health system may comprise modifying the path of light incident onthe user's eyes based on a prescription for the eyes of the user.

In some embodiments, the health therapy protocol comprises providing eyestimulation to the user through the augmented reality display. It willbe appreciated some users may have relatively weaker and relativelystronger eyes. The processor may be configured to provide increased eyestimulation to the weaker eye in comparison to the stronger eye of theuser. In some embodiments, the eye stimulation may comprise healththerapy image information that is selectively directed to peripheryportions of a retina of the user.

As noted above, the health system may comprise an image sensorconfigured to detect a depth of focus of the user's eye. In conjunctionwith providing eye stimulation, the detected depth of focus may be usedby the system to provide the eye stimulation on a depth planecorresponding to that detected depth of focus.

In some embodiments, the health therapy protocol comprises providinglight therapy to the user through the augmented reality display. Forexample, the health system may comprise a light sensor configured todetect user exposure to light of different wavelengths, and the systemmay be configured to administer light to the user based on thewavelengths of light detected by the sensor. In some cases, the systemmay be configured to reduce the amount of blue light propagating to theeye of the user in response to detecting overexposure to blue light,with overexposure corresponding to an amount of blue light that is abovea threshold. The threshold may be set by the user or by clinician, ormay be determined by an analysis performed by the health system in someembodiments. In some other cases, rather than addressing overexposure,the system may be configured to administer light of one or morewavelengths to the user in response to detecting underexposure to lightof the one or more wavelengths. As discussed herein, exposure to lightof different wavelengths at different times or for different durationsmay affect the circadian rhythm of the user. In some embodiments, thesystem may be configured to modify the circadian rhythm of the user byadministering or reducing an amount of light of one or more wavelengthsin light propagating into the eye of the user. Administering or reducingthe amount of light of certain wavelengths may involve changing theamount of light of some wavelengths that are outputted by the displayand/or changing the amount of some wavelengths of light that aretransmitted through the display to the user's eyes.

In addition to circadian rhythm, exposure to light may impact the mentalstate of the user. In some embodiments, the health system may beconfigured to modify the mental state of the user by administering orreducing an amount of light of one or more wavelengths in lightpropagating into the eye of the user. It will be appreciated thatadministering light involves increasing the amount of light of the oneor more wavelengths to propagate into the eye of the user. Theadministering or reduction of light may be conducted in response toparameters sensed by the health system. For example, the health systemmay be configured to monitor the user's physical state, environment,mood, or detect signs of depression or mental abnormalities. A lighttherapy may be selected based upon the results of the detection ormonitoring.

In addition to a display for providing image information, theuser-wearable system may comprise one or more peripheral output devicesfor providing non-optical stimulation to the user. For example, the oneor more peripheral output devices may comprise a vibrator, and theprocessor may be configured to conduct a health therapy protocol thatcomprises instructing the vibrator to provide a massage of the user. Insome embodiments, the vibrator may massage the face or skull the user.In some other embodiments, the system may be configured to utilize thevibrator to provide haptic feedback or tactile alerts to the user. Thevibrator may correspond to the vibrator (30) of FIG. 5.

In some other embodiments, the one or more peripheral output devices maycomprise a speaker. The processor may be configured to provideinstructions to the speaker to conduct a health therapy protocol. Forexample, two or more of the speakers, at least one for each ear, may beprovided and binaural beats may be provided to user through thespeakers.

As noted herein, the ability of the health system to be worn forextended periods of time and/or periodically over extended durations oftime can provide advantages for increasing the efficacy of healththerapy protocols. In some embodiments, the health system may beconfigured to track health data over time. The health system may befurther configured to perform an analysis of contemporaneous health datawith historical health data and to adjust the treatment protocol basedon the analysis.

As discussed herein, the health system may be connected to remotedatabases. Advantageously, this connection allows existing healththerapy protocols to be adjusted and/or new health protocols to beobtained. For example, the system may be configured to download healththerapy protocols based on a condition of the user. The remote databasesmay correspond to the remote data repository (74) of FIGS. 3A-3D.

As discussed herein, the wearable diagnostic system may be worn by aclinician to diagnose a patient. In some embodiments, the wearablediagnostic system may comprise a frame configured to mount on theclinician; an augmented reality display attached to the frame andconfigured to direct images to an eye of the clinician; anoutward-facing image capture device configured to image an eye of apatient; and a processor configured to conduct a health analysis of thepatient based on the image of the eye captured by the image capturedevice. The diagnostic system may be configured to provide a diagnosisusing a stimulus-response-measurement analysis process in which astimulus is applied to the patient to elicit a response, and theresponse to the stimulus is measured by the diagnostic system. In someembodiments, the outward facing camera is configured to image aninterior of an eye of the patient.

It will be appreciated that the user-wearable diagnostic or healthsystem disclosed herein may provide one or more of the followingadvantages. In some embodiments, the head-mounted display may displayimages in a manner that follows the natural accommodation-vergencereflex of users. This can facilitate the long-term wearing of thedevice, by reducing the eyestrain and/or discomfort that conventionalaugmented or virtual reality systems may induce. The proximity of thehead-mounted display to the user, particularly to the user's eyes, andthe ability to gather information over an extended duration canfacilitate diagnostic testing and treatment on an on-going basis. Insome cases, the diagnostic testing and treatment may occur continuouslyor periodically throughout the time that the user wears the head-mounteddisplay, which may be hours or the majority of a day, over with the spanof multiple days, weeks, months or years. Advantageously, the ability togather diagnostic or therapeutic information over an extended durationcan increase the accuracy of the diagnosis and the efficacy of thetherapy. In some embodiments, the health or diagnostic system mayfurther improve health analyses by providing a more dynamic analysis, inwhich data is gathered as the user goes about his/her day performing avariety of actions in a variety of environments, rather than sittingstatically or stressed in a clinician's office.

In some embodiments, the head-mounted display system may provide bothmore information regarding a particular parameter (by detecting thisinformation multiple times over an extended time frame, e.g., of days,weeks, months, or years, as noted above), and a greater variety ofinformation. For example, as disclosed herein, the head-mounted displaysystem may include a plurality of sensors, including sensors thatmonitor the user and sensors that monitor the ambient environment. Itwill be appreciated that sensors that monitor the environment mayinclude outward-facing cameras (e.g., cameras 16 (FIG. 5)). In addition,the health or diagnostic system may include location sensors (e.g., GPSsensors) and the ability to electronically communicate with externalsources of information, such as the remote data repository (74). In someembodiments, the remote data repository (74) may be a cloud-baseddatabase and communication may be conducted through a network, e.g.,over the internet. As discussed herein, the system may detect thelocation of the user and may obtain information characterizing theambient environment, e.g., from the remote data repository. Thisinformation may include, e.g., pollen count, pollution, demographics,environmental toxins, interior climate and air quality conditions,lifestyle statistics, proximity to health-care providers, etc.

The head-mounted display system may allow any of the types of diagnosticinformation for and/or results of the various diagnostic analysesdisclosed herein to be correlated with other information, e.g.,information relating to other physiological parameters of the user,information about the ambient environment, or temporal information suchas the time or date. For example, this other information may be analyzedlocally by the system or a remote processing unit to determine whetherresults of the diagnostic analysis vary depending on any of these otherpieces of information. In some other embodiments, the occurrence of aparticular diagnostic result may be correlated with the occurrence ofparticular environmental conditions. This correlation may be used todevelop therapeutic protocols. If a particular environment and/or objector conditions within the environment is known to trigger an adversephysiological response, the head-mounted display system may beconfigured to display an alert warning of the likely adverse responseand/or recommending that the environment, condition, and/or object beavoided. For example, a camera on the head-mounted display system may beconfigured to detect restaurant menu items (e.g., by using textrecognition to read menus) and may display alerts for items that areknown to or have been correlated in the past with causing an adversephysiological reaction in the user. In addition, the system may beconfigured to recognize items being ingested by the user (e.g., throughimage recognition, through recognition of identifiers such as words orcodes on a food package, etc.) and to correlate subsequent physiologicalreactions in the user to the food. In another example, the inward-facingcamera may detect eye fatigue at the end of a long period of eye strainand may display alerts for ocular stimulus that have been correlatedwith causing eye strain in the user.

In addition, the local system or remote processing unit may have accessto the diagnostic information and/or results for multiple users, and theuser's diagnostic results may be compared to that of other users tofurther validate a link or correlation with any of these other pieces ofinformation.

It will be appreciated that the user-wearable health or diagnosticsystem disclosed herein may provide a user with access to sensitivepersonal health information. In addition, any misattribution of userinformation can adversely impact the efficacy of therapies provided tothe user, and the accuracy of future health analysis results for theuser, particularly where those health results are derived from ananalysis of historical data. Misattribution of personal information mayoccur when, e.g., the system obtains data for the current user of thesystem, but associates this information with another user's historicaldata, e.g. through a system error or an impersonation of a particularuser by another user. Consequently, in some embodiments, theuser-wearable health or diagnostic system is configured to determine orauthenticate the identity of the user before conducting any of themonitoring, diagnostics, or therapies disclosed herein. Suchauthentication may involve simple password entry or other securityinformation input by the user.

In some other embodiments, in addition to, or in place of the entry ofsecurity information by the user, the authentication may be conductedusing biometric data. Such biometric data may include, e.g., fingerprintscanning, iris scanning, or pupil scanning.

In some embodiments, an inward-facing camera, such as one or both of thecameras (24; FIG. 5) may be utilized as an iris scanner for irisrecognition of one or more eyes of the user. Advantageously, the iriscontains unique sets of features that are stable over time and that areunique to each individual. As a result, the sets of features, which maydefine unique patterns, may be used to identify individuals, often witha greater precision than fingerprints. These sets of features may becaptured by the inward-facing camera, e.g., as part of a captured imageof the iris, and the health or diagnostic system may analyze the imageto detect whether a unique set of iris features matching that of the setof iris features of the user are present. If the user's unique set ofiris features is found to be present, then the health or diagnosticsystem notes the match and the user is determined to indeed be wearingthe health or diagnostic system. The system may then proceed to carryingout monitoring, diagnostics, or therapies associated with that user.

In some other embodiments, the inward-facing camera may be used as aretina scanner for one or more eyes of the user. Such a retina scan mayinclude an infrared light emitter (e.g., the light source 2668; FIG.24C) configured to direct light into the user's eye. It will beappreciated that the pattern of blood vessels in a user's retina isunique and typically does not change over time, and that the bloodvessels reflect different amounts of infrared light than surroundingtissue. The unique pattern formed by this differential light reflectionmay be detected by the camera. If the detected retina pattern is foundto match the user's stored retina pattern, then the health or diagnosticsystem provides a signal indicating a match and the user is determinedto indeed be wearing the health or diagnostic system. As above, thesystem may then proceed to carrying out monitoring, diagnostics, ortherapies associated with that user.

In some embodiments, to provide a heightened level of security, multipleauthentication protocols may be conducted before carrying out themonitoring, diagnostics, or therapies. For example, both iris and retinascanning may be conducted. Advantageously, the user-wearable health ordiagnostic system may already include the necessary ophthalmic hardware(e.g., light sources and eye imagers) to conduct the desired eye-basedauthentication.

The user-wearable health or diagnostic system disclosed herein canprovide various other benefits. For example, the integration of a singledisplay device configured for both health diagnosis and therapy canprovide a feedback loop with the user that facilitates the therapy. Insome cases, by continually monitoring the user's health and/orenvironment, real-time alerts may be displayed to facilitate atherapeutic protocol and increase the likelihood that protocols based onbehavior modification are successfully implemented.

It will be appreciated that each of the processes, methods, andalgorithms described herein and/or depicted in the figures may beembodied in, and fully or partially automated by, code modules executedby one or more physical computing systems, hardware computer processors,application-specific circuitry, and/or electronic hardware configured toexecute specific and particular computer instructions. For example,computing systems can include general purpose computers (e.g., servers)programmed with specific computer instructions or special purposecomputers, special purpose circuitry, and so forth. A code module may becompiled and linked into an executable program, installed in a dynamiclink library, or may be written in an interpreted programming language.In some embodiments, particular operations and methods may be performedby circuitry that is specific to a given function.

Further, certain embodiments of the functionality of the presentdisclosure are sufficiently mathematically, computationally, ortechnically complex that application-specific hardware or one or morephysical computing devices (utilizing appropriate specialized executableinstructions) may be necessary to perform the functionality, forexample, due to the volume or complexity of the calculations involved orto provide results substantially in real-time. For example, a video mayinclude many frames, with each frame having millions of pixels, andspecifically programmed computer hardware is necessary to process thevideo data to provide a desired image processing task or application ina commercially reasonable amount of time.

Code modules or any type of data may be stored on any type ofnon-transitory computer-readable medium, such as physical computerstorage including hard drives, solid state memory, random access memory(RAM), read only memory (ROM), optical disc, volatile or non-volatilestorage, combinations of the same and/or the like. In some embodiments,the non-transitory computer-readable medium may be part of one or moreof the local processing and data module (70), the remote processingmodule (72), and remote data repository (74). The methods and modules(or data) may also be transmitted as generated data signals (e.g., aspart of a carrier wave or other analog or digital propagated signal) ona variety of computer-readable transmission mediums, includingwireless-based and wired/cable-based mediums, and may take a variety offorms (e.g., as part of a single or multiplexed analog signal, or asmultiple discrete digital packets or frames). The results of thedisclosed processes or process steps may be stored, persistently orotherwise, in any type of non-transitory, tangible computer storage ormay be communicated via a computer-readable transmission medium.

Any processes, blocks, states, steps, or functionalities in flowdiagrams described herein and/or depicted in the attached figures shouldbe understood as potentially representing code modules, segments, orportions of code which include one or more executable instructions forimplementing specific functions (e.g., logical or arithmetical) or stepsin the process. The various processes, blocks, states, steps, orfunctionalities can be combined, rearranged, added to, deleted from,modified, or otherwise changed from the illustrative examples providedherein. In some embodiments, additional or different computing systemsor code modules may perform some or all of the functionalities describedherein. The methods and processes described herein are also not limitedto any particular sequence, and the blocks, steps, or states relatingthereto can be performed in other sequences that are appropriate, forexample, in serial, in parallel, or in some other manner. Tasks orevents may be added to or removed from the disclosed exampleembodiments. Moreover, the separation of various system components inthe embodiments described herein is for illustrative purposes and shouldnot be understood as requiring such separation in all embodiments. Itshould be understood that the described program components, methods, andsystems can generally be integrated together in a single computerproduct or packaged into multiple computer products.

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. Forexample, in addition to scanning fiber displays (FSDs), it will beappreciated that the projected light and images for embodimentsdisclosed herein may be provided by other types of displays. Examples ofsuch other types of displays include liquid crystal displays,micromirror-based displays (e.g., DLP displays), and OLED displays.

In some embodiments, in addition to or as an alternative to theapplication of liquids to the eye, solid state materials such as powdersor powdered medications may also be delivered to the eye by theophthalmic system.

The specification and drawings are, accordingly, to be regarded in anillustrative rather than restrictive sense.

Indeed, it will be appreciated that the systems and methods of thedisclosure each have several innovative aspects, no single one of whichis solely responsible or required for the desirable attributes disclosedherein. The various features and processes described above may be usedindependently of one another, or may be combined in various ways. Allpossible combinations and subcombinations are intended to fall withinthe scope of this disclosure.

Certain features that are described in this specification in the contextof separate embodiments also can be implemented in combination in asingle embodiment. Conversely, various features that are described inthe context of a single embodiment also can be implemented in multipleembodiments separately or in any suitable subcombination. Moreover,although features may be described above as acting in certaincombinations and even initially claimed as such, one or more featuresfrom a claimed combination can in some cases be excised from thecombination, and the claimed combination may be directed to asubcombination or variation of a subcombination. No single feature orgroup of features is necessary or indispensable to each and everyembodiment.

Headings are used throughout this application as an organizational aidfor the reader. These headings may group together examples of methods,apparatuses, and structures that may generally relate to a particulartopic noted in the headings. It will be appreciated, however, that whilethe various features discussed under the heading may relate to aparticular topic, the headings should not be understood to indicate thatthe features discussed under a given heading are limited inapplicability only to the topic or topics that listed in the heading.For example, a heading may be labeled “Myopia/Hyperopia/Astigmatism”.However, the subject matter included under this heading may equally beapplicable to subject matter contained in any other section, such ascontent under the heading “Presbyopia,” “Retinoscopy.” “Autorefractor,”and other sections. Alternatively, subject matter from other sectionsmay also be applicable to the “Myopia/Hyperopia/Astigmatism” sections.

Indeed, as shown in various figures (e.g., FIG. 5), structures forvarious health analyses and/or therapies may coexist in the same healthsystem. Moreover, as disclosed herein, the same feature may be appliedto facilitate multiple health analyses and/or therapies. For example,structures used for delivering medication may also be utilized forvarious diagnostics, as disclosed herein. Consequently, health systemsaccording to some embodiments may include various combinations of thestructural features disclosed herein, including combinations of featuresdisclosed under different headings. In addition, the health system maybe configured to perform various combinations of the health analyses andtherapies disclosed herein, including those disclosed under differentheadings.

It will be appreciated that conditional language used herein, such as,among others, “can,” “could,” “might,” “may,” “e.g.,” and the like,unless specifically stated otherwise, or otherwise understood within thecontext as used, is generally intended to convey that certainembodiments include, while other embodiments do not include, certainfeatures, elements and/or steps. Thus, such conditional language is notgenerally intended to imply that features, elements and/or steps are inany way required for one or more embodiments or that one or moreembodiments necessarily include logic for deciding, with or withoutauthor input or prompting, whether these features, elements and/or stepsare included or are to be performed in any particular embodiment. Theterms “comprising,” “including,” “having,” and the like are synonymousand are used inclusively, in an open-ended fashion, and do not excludeadditional elements, features, acts, operations, and so forth. Also, theterm “or” is used in its inclusive sense (and not in its exclusivesense) so that when used, for example, to connect a list of elements,the term “or” means one, some, or all of the elements in the list. Inaddition, the articles “a,” “an,” and “the” as used in this applicationand the appended claims are to be construed to mean “one or more” or “atleast one” unless specified otherwise. Similarly, while operations maybe depicted in the drawings in a particular order, it is to berecognized that such operations need not be performed in the particularorder shown or in sequential order, or that all illustrated operationsbe performed, to achieve desirable results. Further, the drawings mayschematically depict one more example processes in the form of aflowchart. However, other operations that are not depicted can beincorporated in the example methods and processes that are schematicallyillustrated. For example, one or more additional operations can beperformed before, after, simultaneously, or between any of theillustrated operations. Additionally, the operations may be rearrangedor reordered in other embodiments. In certain circumstances,multitasking and parallel processing may be advantageous. Moreover, theseparation of various system components in the embodiments describedabove should not be understood as requiring such separation in allembodiments, and it should be understood that the described programcomponents and systems can generally be integrated together in a singlesoftware product or packaged into multiple software products.Additionally, other embodiments are within the scope of the followingclaims. In some cases, the actions recited in the claims can beperformed in a different order and still achieve desirable results.

Accordingly, the claims are not intended to be limited to theembodiments shown herein, but are to be accorded the widest scopeconsistent with this disclosure, the principles and the novel featuresdisclosed herein.

1. (canceled)
 2. A wearable augmented reality device comprising: anaugmented reality head-mounted ophthalmic system comprising a wearableaugmented reality display platform configured to pass light from theworld into an eye of a wearer wearing the head-mounted ophthalmicsystem, wherein the augmented reality display platform comprises anoptical coherence tomography system configured to image the eye.
 3. Thedevice of claim 2, wherein the optical coherence tomography system isconfigured to project light beams of varying wavelengths.
 4. The deviceof claim 3, wherein the wavelengths include visible wavelengths.
 5. Thedevice of claim 3, wherein the wavelengths include infrared wavelengths.6. The device of claim 2, wherein the wearable augmented reality displayplatform comprises a 3D scanning head comprising a fiber scanningdevice.
 7. The device of claim 6, wherein the fiber scanning device isconfigured to project light beams into the eye.
 8. The device of claim6, wherein the fiber scanning device is configured to receive light fromthe eye.
 9. The device of claim 2, further comprising an eye trackingsystem configured to measure eye movement, wherein the ophthalmic systemis configured to de-noise the optical coherence tomography images,wherein de-noising comprises discarding optical coherence tomographyimages based on measured eye movements.
 10. The device of claim 2,further comprising ERG.
 11. The device of claim 2, where the opticalcoherence tomography system comprises a light source configured to varyan angle at which light is projected to the eye based on regions of theeye space to be imaged.
 12. The device of claim 2, further comprisingone or more inward facing cameras configured to receive light from theeye.
 13. The device of claim 12, wherein the one or more inward facingcameras comprise at least one CMOS sensor.
 14. The device of claim 2,further comprising a plurality of photodetectors positioned at differentparts of the system.
 15. The device of claim 14, wherein thephotodetectors may be positioned around a rim of the head-mountedophthalmic system.
 16. The device of claim 14, wherein thephotodetectors may be positioned around the periphery of a frame of thehead-mounted ophthalmic system.
 17. The device of claim 2, wherein thedisplay platform comprises an adaptable optics element configured tomodify angles for propagation of light to the eye.
 18. The device ofclaim 17, wherein the adaptable optics element comprises a variablefocus element.